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Complementary and alternative medicine (CAM) in cancer: An evidence-based systematic review of the efficacy and safety of CAMs, and the perceived vs real benefits of CAM use for the quality of life and psychological adjustment of cancer patients undergoing cytotoxic treatment

Pirri, Carlo (2014) Complementary and alternative medicine (CAM) in cancer: An evidence-based systematic review of the efficacy and safety of CAMs, and the perceived vs real benefits of CAM use for the quality of life and psychological adjustment of cancer patients undergoing cytotoxic treatment. PhD thesis, Murdoch University.

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Complementary and alternative medicine (CAM) continues to evoke fierce debate and divergent views within the medical community. Nevertheless, it remains an attractive and commonly used treatment option for many cancer patients regardless of whether their doctors like it or believe in it. Complementary medicine is used by 14-65% of Australian adult cancer patients (up to 73% in Europe and 91% in the US), and alternative medicine by 8-14%. It is therefore important that clinicians have an awareness of the type of patients that are likely to use CAM, as well as a good understanding of the levels of evidence available for the efficacy and safety of specific complementary and alternative therapies. Two large studies were performed to this end.

Study 1 examined the incidence and type of complementary therapy (CT) use, perceived benefits of use, and the relationship between demographic, clinical or quality of life/psychological factors and use in 200 Australian cancer patients across conventional chemotherapy-based treatment. Overall, 30% of patients reported CT use. CT users were predominantly younger, tertiary educated, possessed comorbid conditions and underwent lengthy treatment (.004 ≥ p ≤ .023). Patients who underwent lengthy treatment (> 6 months) were 3 times more likely to use complementary therapies. Of all CT users, 64% perceived benefit and primarily cited enhanced physical and emotional well-being. CT users, however, did not score significantly better than non-users on any measure of quality of life, physical health or psychological adjustment. CT users generally reported greater psychological distress than non-users across treatment, particularly at pretreatment (baseline). However, with ongoing/new CT use these patients significantly reduced their distress levels to that of non-users by 8 weeks on-treatment (p = .042).

Study 2 entailed a systematic review of the benefits and health risks of popular CAMs used by cancer patients. Specifically, the efficacy and safety of over 50 individual CAMs were examined across 363 publications, including over 300 metaanalytic/ systematic reviews. Evidence indicated that some CTs are beneficial in reducing disease/treatment symptoms and improving quality of life and psychological adjustment (e.g. relaxation), and in years to come may be integrated into everyday clinical practice. Evidence of potential harm, however, also exists. Nutritional supplements, herbal preparations and other natural therapies may pose direct safety risks because of their potential adverse effects or interactions with conventional anticancer treatments and other medications. Some should not be used by cancer patients under any circumstances irrespective of benefit (e.g. St. John’s wort), while others are beneficial and safe under medical supervision (e.g. valerian). Alternative therapies promoted as “cures” in place of conventional treatments (e.g. laetrile/amygdalin) potentially cause patients the most harm.

Collectively, the studies demonstrated that CTs, at the very least, may enhance the psychological well-being of cancer patients during the early stages of conventional medical treatment. Indeed, CT use by cancer patients may be a clinical marker for psychological distress, and should trigger clinicians to enquire about physical symptoms and concomitant anxiety and depression. Research, however, indicates that 20-77% of patients do not disclose CAM use to their physicians. Moreover, discussions about CAM are uncommon and are most likely to be initiated by patients rather than physicians, many of whom believe that they cannot effectively communicate with patients about CAM use partly due to having insufficient knowledge about the efficacy and safety of specific CAMs. Patients’ perceptions that CAMs are more “natural” and safer than conventional treatments are problematic. Indeed, they may pose direct safety risks. It is therefore imperative that those involved in the medical care of cancer patients are equipped with the skills and knowledge to help patients appropriately evaluate CAMs, in order to receive benefit while avoiding harm. Additionally, clinicians are strongly encouraged to routinely ask patients about CAM use. Offering evidence-based complementary therapies (or at least safe forms of them) alongside conventional treatments in cancer services can influence patients’ decisions to continue with mainstream care, and help avoid any potential harm that may occur with autonomous CAM use.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): School of Psychology and Exercise Science
Supervisor(s): Drummond, Peter
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