Complementary Therapies

Key messages

  • Complementary therapies are widely used in the Australian community, and are often adopted by palliative care patients. There is growing interest in seeking evidence regarding the effectiveness of complementary therapies for palliative care patients, and findings regarding some specific therapies are discussed in the following pages.
  • Many specialist palliative care services now offer complementary therapies – most often mind-body and “touch therapies” - as part of their supportive care for patients and their carers. Guidelines are available to help develop good clinical practice for this aspect of patient care (see below).
  • Clinicians are often not informed or aware that their patients are using complementary therapies. It is important to actively seek this information, in order to explore patients’ expectations and to minimise the risk of drug interactions or adverse effects.
  • Patients should be counselled about reliable information sources and advised to seek out appropriately trained complementary therapists.
  • Herbal therapies and supplements in particular can sometimes be associated with drug interactions or other risks. Up to date online information is available from the Memorial Sloan Kettering’s Integrative Medicine Department website About Herbs which can help health care providers advise patients about potential positive and negative effects of these treatments.

Background

Complementary therapies are defined by the US National Center for Complementary and Alternative Medicine (NCCAM) as “a group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.”

Complementary therapies are widely used in the general Australian community. Patients receiving palliative care often continue or explore using complementary therapies alongside their other health care. Patients may have a variety of reasons for this including wanting a therapeutic response, wanting control, a strong belief in CAM, CAM as a last resort, and finding hope. [1] A number of specialist palliative care services now offer a range of complementary therapies for their patients, and for their patients’ families and carers. Most commonly these would include massage, aromatherapy, relaxation, meditation, acupressure, or art and music therapy.

An evidence base is now developing which provides support for the role of some therapies in improving the symptoms and / or quality of life of palliative care patients, although for some complementary therapies very little positive evidence is available. When complementary therapies like herbs or supplements are taken orally, topically or by some other route, it is important to consider the possibility of drug interactions and side effects. This is particularly so for patients receiving concurrent treatment with chemotherapy, radiotherapy, or medications for symptom control, or who have significant organ impairment, such as renal or hepatic disease. Complementary therapy use should therefore be regularly monitored throughout the course of a person’s illness.

The development of complementary therapies has been strongly driven by consumer demand, and the process of evaluating the efficacy, benefits, and occasionally harms associated with this rapidly growing health sector has been somewhat slower. Some commonly used treatments are not supported by good evidence, and sometimes strong evidence exists that they are ineffective, or may even cause some harm. The treatments listed here have some high level evidence – positive or negative - which is relevant to their use in a palliative care population. The list of therapies is not exhaustive, as not all therapies that are commonly used have had sufficient research done to allow systematic reviews of the evidence to be completed:

Active research areas / controversies

  • Occasionally users of alternative therapies – unconventional or complementary treatments which are used instead of standard medical treatment - require care from a palliative care service. The prevalence and outcomes of alternative therapy use in palliative care populations has not been well-studied. Little research has been done about the special needs and issues of this group of patients, who may be unaccepting of palliative care or other standard medical treatments, and yet have significant pain, symptoms and distress.
  • Investigation of complementary therapies is still developing. Many studies in the literature have been poorly designed, or have methodological problems which make their findings unreliable. Developing appropriate ways of studying complementary therapies is quite challenging, and requires attention to standardising the interventions, ensuring adequate numbers of participants, eliminating bias, and ensuring good blinding procedures. This is an evolving area of clinical research.

PubMed Searches

Complementary Therapies
Free full text only All citations About these searches

Review Collection
  1. Verhoef MJ, Balneaves LG, Boon HS, Vroegindewey A. Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review. Integr Cancer Ther. 2005 Dec;4(4):274-86.

The following book (with associated CD) is recommended as an evidence-based summary of the literature on complementary therapies. It is not a free online resource but is extremely comprehensive.

  • Ernst E, Pittler MH, Wider B. The desktop guide to complementary and alternative medicine: an evidence based approach. 2nd ed. Philadelphia. PA: Mosby Elsevier; 2006.

Guidelines

Links to detailed information

These databases contain valuable information for clinicians, and also for patients seeking evidence-based information about complementary therapies. 

  • National Center for Complementary and Alternative Therapy
    Has an overview of complementary and alternative therapies and information and factsheets designed for patients
  • Memorial Sloan Kettering Cancer Center website: About Herbs
    Contains detailed information for clinicians about botanicals and other complementary therapies that are frequently used by cancer patients, including summaries of known effects, adverse effects and interactions. 
  • Office of Dietary Supplements 
    Specific information for clinicians on dietary supplements, antioxidants and botanicals; also a useful set of factsheets for patients, and online resources about informed decision-making to help patients evaluate information about complementary and alternative therapies.

Overview articles

Last updated 18 January 2017