3.1. Complementary and Alternative Medicine (CAM) and Cancer Patients
Complementary therapies have an increasingly important role in the control of symptoms associated with cancer and cancer treatment.
Referring national researches in 2007, generally, 38% of adults and 12% of children use Complementary and Alternative Medicine in United States (
1, 2). Also, researches issued in 1999 in case of cancer patients show that 25% to 83% of them have used complementary medicine in different stages of diagnosis on which geographic location and type of cancer was effective ( 3, 4). Recent studies indicate that employing complementary medicine for children with cancer has changed from 31% to 92% ( 4).
Middle East countries have witnessed that CAM has an important role in supportive cancer care and is often used in association with traditional medicine.
There has been a movement over the last 20 years to include complementary medicine in Western biomedicine mainstream practices. Varying degrees of success have been reported but for the discipline of oncology, complementary medicine is now being taught in the public university system to a PhD level as well as the public demand for their medical doctors to communicate with their complementary medicine practitioners. Medical oncology specialists are now open to a dialogue with their complementary medicine counterparts.
In a study in Canada a series of in-depth qualitative interviews with various oncology health professionals recruited from cancer agencies, hospitals, integrative clinics, and private practice settings were reviewed and findings demonstrated two main strategies used by oncologist to create a more integrative approach for cancer patients: acting as an integrative care guide, and cooperating with other health professionals.
Also, studies in Western countries show that educated society with higher level of education and income make more use of complementary medicine (
5, 6). It is more prevalent to use complementary medicine in young women who have background of surgery, chemotherapy and using complementary medicine ( 7).
Cancer survivors withstand a wide range of side effects and unwelcome complications during and following completion of treatment, and some of these symptoms may persist for months and years or even decades. While pharmacologic treatments alleviate some symptoms, they produce some difficult side effects. More complementary modalities are noninvasive, inexpensive, and useful in reducing symptoms and improving quality of life. Some high quality scientific research has produced evidence that acupuncture, massage, music, and mind-body therapies effectively and safely reduce physical and emotional affects. These therapies provide an appropriate risk-benefit ratio and authorize cancer care professionals to help manage their own care.
Many of cancer patients experience fatigue, pain, anxiety, and mood suffer whereas conventional treatments do not evermore satisfactorily relieve these symptoms.
A multidisciplinary approach in integrative oncology as mind-body modalities and massage therapy can reduce fatigue, anxiety, and chronic pain.
3.2. Health Care Professionals’ Approach to Integrative Oncology Foundation
Using integrative medicine in oncology has its origin in these principal bases: comprehensiveness, specificity, evidence-based entity, and safety (
8). This method has been established in response to the concept of treatment with all its aspects.
Integrative oncology relates to an emerging conversation between CAM scholars, oncology care professionals, family practitioners, and other health care providers who imagine an expanded and holistic patient-centered approach to oncology care.
Conventional model of cancer treatment including surgery, radiotherapy and chemotherapy in integrative oncology expands to a multi-disciplinary approach involving all types of CAM modalities like traditional systems as Persian and Chinese medicine, acupuncture, yoga, relaxation, sport, massage, dietary and nutritional therapies, herbal medicine, homeopathy, mind-body medicine, shiatsu, and therapeutic touch.
Without a comprehensive evaluation and fulfillment of patients’ whole needs, they absolutely feel a remarkable treatment gap. Symptoms like severe pains or nausea are purely physical sings but when they become chronic, they will show mental effects and will affect patient’s social and behavioral state, as an example they will lead to irritability, isolation and insomnia-related fatigue.
The patient is much more likely to say all his needs in an extensive treatment plan in which all dimensions including nutrition/regime, physical activity, side-effect control, sleep, fatigue, digestion, and appetite has been considered.
Studies reveal that cancer patients by using CAM methods hope to support their immunity system, soothe their pains, and reduce side effects of cancer and its treatment. Only a few patients use CAM treatments due to inefficacy of conventional treatments, so, their motive for using CAM depends on sense of more control on their health, reduction of side effects and strong believe in natural therapy (
Certain that cancer patients report that they desire to be able to consult with their conventional health practitioners, particularly their oncologists, about their CAM use, health professionals who select to accept integrative practices are likely proposing patients much-welcomed support.
3.3. Conventional Medicine Approach to Integrative Medicine in Cancer Treatment
So far many CAM therapies have been carefully scrutinized and this trend is growing. In 2009 society for integrative oncology issued evidence-based clinical practice guidelines which should be regarded while using complementary therapeutic methods by doctors in cancer treatments. Also, researchers are evaluating those methods of CAM that people use to lower risk of cancer.
Some of the academic centers which specifically work as comprehensive cancer control centers in integrative medicine are listed in the
Table 1, also, updated information and confirmed/approved researches are accessible in the following centers ( Table 2).
Table 1. Academic Centers Which Specifically Work as Integrative Oncology Departments
Location Academic Centers Arizona Cancer Treatment Centers of America ( 10) California University of California San Francisco, Osher Center for Integrative Medicine ( 11). Simms/Mann-UCLA Center for Integrative Oncology ( 12) Illinois The Block Center for Integrative Cancer Treatment ( 13). Cancer Treatment Centers of America ( 10) Maryland Johns Hopkins Center for Complementary and Alternative Medicine ( 14) Massachusetts Dana Farber Cancer Institute, Leonard P. Zakim Center for Integrative Therapies ( 15) Minnesota Mayo Clinic's Complementary and Integrative Medicine Program ( 16) New York Memorial Sloan Kettering Cancer Center, Integrative Medicine Service ( 17) Oklahoma Cancer Treatment Centers of America ( 10) Pennsylvania Cancer Treatment Centers of America ( 10) Texas The University of Texas MD Anderson Cancer Center, Integrative Medicine Program ( 18) MD Anderson Cancer Center http://www.mdanderson.org ( 19) The Society for Integrative Oncology http://www.integrativeonc.org ( 20)
Table 2. Some Centers for Access Updated Information and Confirmed/Approved Researches
Center Type of Activity Website NCCAM clearinghouse The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. nccam.nih.gov National Cancer Institute The National Cancer Institute is the Federal Government’s lead agency for cancer research. The National Cancer Institute’s Cancer Information Service provides comprehensive information about cancer. The National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine coordinates and enhances the National Cancer Institute’s activities in CAM research. www.cancer.gov PubMed® A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed®, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM. www.ncbi.nlm.nih.gov/sites/entrez CAM on PubMed®: nccam.nih.gov/research/camonpubmed/
Table 3. Some Symptoms and Disorders are More Focused in Integrative Oncology Centers
Filed Symptoms and Disorders Mental and nervous system Stress, Anxiety & Depression; Neuropathy; Sleeping Problems & Insomnia Gastrointestinal system Poor Appetite & Weight Loss; Nausea & Vomiting; Constipation; Diarrhea; Taste Change; Difficulty Swallowing; Mouth Sores; Dry Mouth Other systems Shortness of Breath; Vaginal Dryness & Pain General symptoms Fatigue; Pain; Hot Flashes; Skin Care & Nail Care; Lymphedema
The rapeutic methods used in these centers are based
on following principals:
1. Psychological Support
2. Mind-Body Approaches
3. Groups and Counseling
4. Nutrition, Supplements
5. Complementary Medicine
6. Psychiatry and Oncology
7. Insights Into Cancer
The most common CAM modalities used in these centers are as follows:
traditional systems as Persian medicine, Chinese medicine, ayurveda; acupuncture; massage; spirituality; aromatherapy; art therapy; biofeedback; meditation; music therapy; tai chi; yoga; botanical medicine; breath work; Chinese herbs; chiropractic; clinical hypnosis; cranio-sacral therapy; creative therapies; cupping; dermal friction; dietary therapies; food as medicine; healing environment; homeopathy; imagery; mind-body therapies; mindful movement; moxibustion; naturopathy; osteopathy; prayer; qigong; reflexology; reiki; shamanism; shiatsu; social support; therapeutic touch.