Background to complementary and alternative therapy use
Complementary and alternative therapies (often called CAMs) cover a wide spectrum, from unorthodox cancer treatments which may be costly and invasive, through to self-care activities which, for many patients, may be part of their usual spiritual or health care practices, like meditation, relaxation or prayer. The US research organisation NCCAM has provided a useful set of definitions of CAMs.
It is important to distinguish between complementary therapies (provided alongside standard medical care) and alternative therapies (used in place of standard medical care.) Little is known about the prevalence and outcomes of use of alternative therapies in the palliative care population. These issues are monitored and discussed on the Quackwatch website.
The evidence supporting the use of complementary therapies by palliative care patients is patchy. The Bandolier website contains much of this evidence. Nonetheless there is substantial use of these therapies by patients, and some complementary therapies are also now offered as an integral part of supportive care by many palliative care services. Moreover, many patients who use complementary therapies report high levels of satisfaction and perceived benefit from using such therapies. Their popularity mirrors the interest in “natural” and non-medical treatments across the whole community. In some non-western cultures, some of these therapies have held a central place in traditional systems of health care. Patients from different cultural backgrounds may therefore view the role of these therapies differently to that of western health care providers.
Despite widespread use, there are still many important unanswered questions about where the boundaries should be between standard health care and CAMs. There is a trend to try to incorporate CAMs into standard health care as the evidence becomes available that various practices are safe and potentially beneficial, currently called “integrative medicine” – but this is still controversial.
The main problems are that:
- these therapies are largely unproven, and often make claims which are not scientifically plausible
- the lack of agreed definitions means that a diverse range of therapies have been variouslyreferred to complementary or alternative, despite significant differences between these therapies. As a result, it is problematic to distinguish those complementary therapies which may provide benefit to patients from those which are not beneficial or harmful
- they are frequently provided outside the framework of standard health care
- they have been difficult to regulate, and adverse effects and drug interactions may be under-identified
- there can be concerns about the training and practices of some practitioners.
Considerations for practice
Palliative care providers will see many patients who are receiving complementary and or alternative therapies. Patients may be using these therapies for many different reasons, including hope for a cure, comfort, or to promote or maintain health and wellbeing. The quality of information available to people regarding CAMs is also highly variable. This may raise issues, including:
- what good quality information is available to help advise people who are considering, or are already using CAMs, and what are their expectations of the goals of treatment?
- what is the health care provider’s responsibility with regard to their patients’ use of CAMs and what are the limits on this?
- whether the person accepts and understands that there may be risks and burdens associated with some complementary and alternative therapies, and that some of these cannot be easily predicted?
- what are the person’s needs for support, and how best may these needs be met?
Given the high prevalence of undisclosed CAM use, patients should be asked whether they are using non-medically prescribed treatments of any kind, including over the counter remedies, and a level of pharmacovigilance should be maintained for potential drug interactions and adverse effects.
This page was created on 12 May 2006 and is due for review in May 2008
This page is currently under review.