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Complementary and Alternative Therapies for Cancer Patients UNDERSTANDING YOUR
CHOICES A. The Scope of this Handbook You and your family are likely to face many decisions, one of which may be whether or not to choose a complementary or alternative therapy. When should this choice be made? What types of treatments should be considered and who should provide them? How successful is the therapy being considered? Will committing to an "unproven" therapy provoke criticism from your physicians and/or your family? These questions are difficult to answer. The difficulty lies in the fact that there is so much information to gather, understand and use in making these choices. Additionally, you may find this to be a complicated decision due to the range of differing opinions as to what is considered a complimentary or alternative therapy. Your health care providers, family, friends and/or and national institutions such as the National Cancer Institute (NCI) and the American Cancer Society (ACS) may each offer a different perspective. Currently, cancer patients use a wide variety of complementary or alternative therapies. The purpose of this handbook is not to suggest that any of the reviewed therapies should be pursued. Instead, the goal is to help you get the information you need to make informed choices. The starting point for making informed choices is the recognition that you can play a critical role in your battle with cancer. Scientifically, it is not known whether personal efforts at healing make a difference in life extension. However, most psychotherapists report that cancer patients who are actively engaged in personal healing methods can make a difference in the quality of their lives. "There
is no such thing as false hope for a cancer patient.
Hope is as unique with each individual as a fingerprint.
For some it is the hope to make a complete recovery. But it might also be the hope to die peacefully; the hope to live
until a specific event happens; the hope to live with the disease; the
hope to have their doctor with them when needed; the hope to enjoy today. Just as each case of cancer is unique, each
person is different. Each individual
has the right to be told all their options and then decide for themselves."
(Richard A. Bloch, Co-founder and Honorary Chairman of the Board
of H&R Block, Inc.) Increasing amounts of scientific evidence suggest that a strong desire to live and active steps taken to improve the healthful quality of life do help some people in their efforts towards physical recovery. Within this broad category of complementary and alternative therapies are relatively safe approaches, geared towards improving quality of life and tolerance of standard cancer treatments, to much more radical approaches which possess significant toxicity and unknown benefits. This handbook will provide guidance in obtaining, understanding and evaluating information available about these approaches to treatment. What
you do with the information presented to you in this handbook is your
responsibility. Each one of
you must take the responsibility to make informed health care choices.
No one cancer therapy holds or health care provider knows the
miraculous cure for cancer. Because every patient is a unique individual
physically, mentally, emotionally and spiritually, a treatment that
is effective for one patient may not work at all for another patient
with the same condition. Your
overall health and well-being are vital components in your battle with
cancer. As part of your cancer journey, we therefore
encourage you to listen to your body, learn about the therapies that
may be of interest to you and communicate your needs to those involved
in your care. We hope that this handbook is a resource for
you in this process. B. Wellness and Integrative Medicine
Central
to complementary and alternative medicine is the concept of wellness and the relationship between the mind, body and spirit.
Wellness is not simply defined as the absence of disease.
Instead, it is a continual process of searching for and using
those tools which enable you to achieve a sense of well-being and a
feeling of wholeness, even in the face of illness.
Wellness programs and complementary and alternative medicine
(CAM) therapies focus on what comprises health, causes illness and promotes
emotional, physical and spiritual well-being.
These therapies are the foundation of our progress toward a system
of integrative medicine, a combination of the best offerings of both
conventional and alternative therapies. Integrated medicine uses an individualized
approach to treatment and involves the patient in his or her recovery. C. Comparing CAM and Conventional
Medicine Philosophies Many complementary and alternative therapies rely on the natural healing ability of the human body. These therapies are founded on the belief that within all of us is a natural ability to heal. This philosophy is in sharp contrast to conventional medicine’s traditional focus on the techniques and technology needed for healing. CAM practitioners may therefore take the approach of supporting and stimulating the healing potential within each individual, recognizing that certain stimuli may enhance this natural healing. Healing can take place at the physical, emotional, mental or spiritual level. Other unifying themes of complementary and alternative medicine include: •
Importance of spiritual values to health At the 1996 American Medical Association National Leadership Conference, Dr. Jeremiah Barondesa stated that many physicians might not deal effectively enough with illness, elements he identifies as symptoms, anxieties and concerns that make people feel sick. Instead of an emphasis on promoting overall wellness, there has traditionally been a focus on treating disease, defined in biochemical terms that are too far removed from the person being examined. It
has been suggested that "the soothing attention of complementary
practices, including psychosocial care, along with the technical expertise
of oncology practice is a merger that can greatly enhance patients'
quality of life and satisfaction with care." Within integrated medicine, a patient is evaluated
and treated as a whole, with attention paid to all physical, mental,
emotional and spiritual signs of dysfunction.
Because it draws from both conventional and alternative therapies,
integrated medicine has a wider range of therapeutic options than either
one alone. Treatment generally
starts with the safest, less invasive therapies and moves to more invasive
interventions as it becomes necessary. D. Changing Times and Attitudes Our nation’s current health care system is built upon a tradition of treating disease rather than restoring wellness. Despite phenomenal technical and pharmaceutical advancements in treatment of illness and disease, the limitations of the “high tech” approach are now becoming more obvious. These limitations include ignoring the impact of mental and spiritual health and well-being on disease. Accordingly, up to fifty percent of cancer patients in the U.S. now use complementary and alternative medicine, mostly in addition to their conventional treatment despite limited evidence of efficacy. This percentage may be even larger if lifestyle changes such as prayer, journaling, diet and exercise are taken into account. The
increase in the use of alternative medicine has been accompanied not
only by growing patient interest but also by more accepting attitudes
of physicians. In 1998, the American Medical Association (AMA)
ranked alternative medicine as the third most important topic for continuing
research efforts. Thirty-four
of the 125 U.S. medical schools offer training in alternative medicine.
Residency programs (continuation of training after medical school)
in "Integrated Medicine" are becoming increasingly available
for physicians. Such programs are being developed or are already
in place at Duke, Harvard, University of Arizona, University of Massachusetts,
Thomas Jefferson, University of California San Francisco and the University
of Minnesota. E. Terminology and Treatment Types Part of the difficulty in exploring treatment options is the confusing terminology used in medical literature. Terms used to describe different categories of treatment include standard, conventional, proven, investigational, experimental, clinical trial, alternative, complementary, integrative, questionable, unconventional and unproven. Understanding these terms will help you to evaluate the different options you are considering. Standard, or conventional, treatments are those which employ a type of treatment taught in Western medical schools. They have been tested following a strict set of guidelines and found to be effective on a specific population of patients. Presently, surgery, radiation therapy and chemotherapy are the most common conventional treatments for cancer. However, standard treatments are culturally defined. What is considered standard in one culture may be different from another. For example, cancer therapy in the U.S. is more aggressive than any other technologically advanced nation. The aggressiveness of American cancer therapy does extend life for some patients, but for other patients, the effect on quality of life issues outweighs the benefits of the aggressive approach. Other countries, such as France and Germany, take a gentler approach to cancer treatment and are very open to the use of homeopathy and naturopathy. Very few studies have been done to compare the differences in efficacy of cancer therapies in other advanced nations, but currently there is no known difference in treatment outcome between advanced nations. For some types of cancer, standard therapy may lead to elimination of disease and/or significantly prolong survival. For other types of cancer, standard therapy may only have a small likelihood of extending life expectancy. Proven treatments, generally the first type of treatment prescribed by doctors, have been shown to have some benefit to patients with a specific type of cancer through a series of carefully controlled research studies. These research studies evaluate the treatment first for safety and dosage, next for response by specific cancer types and finally in comparison to standard treatments for a specific cancer type. The results of these studies have been published in peer-reviewed journals, and the treatment has been approved by the U.S. Food and Drug Administration (FDA). The FDA is the agency charged with enforcing the Federal Food, Drug and Cosmetic Act which states that all treatments must be conclusively proven to be safe and effective for their stated purpose before they can be legally distributed in the United States. Investigational, or experimental, treatments are those going through a carefully structured, closely monitored process to determine if they are effective treatments for cancer. Before a drug can be used regularly to treat patients, it is first studied and tested in laboratory test tubes and then in animals to determine whether it is a promising treatment. When a new drug treatment begins the experimental process in humans, it is labeled an investigational new drug (IND) and is registered and approved by the FDA for testing. A clinical trial is a research study in which patients volunteer or agree to participate in order to evaluate a new treatment or combination of treatments. This is a long process and involves three phases, each with a different goal, to evaluate the efficacy of the new treatment. In Phase I clinical trials, the new drug is given to a small number of patients. The goals are to determine the best method of drug administration and the appropriate dosages that can be safely administered. Doses of the drug increase throughout Phase I treatments until the maximum dose that can be safely administered to patients is determined. The information from Phase I clinical trials is used to design the next step, Phase II trials. In Phase II testing, the researchers want to determine the efficacy of the treatment on various types of cancer. If the treatment provides some efficacy in Phase II trials, it may go on to Phase III testing where it will be compared directly with a standard treatment to determine which is most effective. Through this lengthy and careful process, investigational treatments become proven treatments and are incorporated as part of the standard treatment for a specific type of cancer. Complementary and alternative medicine (CAM) includes a broad range of healing approaches, therapies and philosophies. CAM therapies are practiced to try to prevent illness, reduce stress, improve well-being, prevent or reduce side effects and symptoms or to control or cure disease. According to the NCI, a treatment is called complementary when it is used in conjunction with conventional treatments to enhance well-being or help with symptom control. Alternative therapy refers to treatments that are unproven because they have yet to be scientifically tested or were tested and found to be ineffective. Alternative therapies are often used in place of conventional treatments. Depending on how they are used, some therapies are considered either complementary or alternative. Integrative therapy is a term used to describe the combined offering of conventional and complementary therapies to stimulate the body's natural healing process. Stressing prevention and self-care, it neither rejects conventional medicine nor blindly accepts alternative practices. Integrative medicine is different than complementary medicine, which emphasizes the use of unconventional treatments as an adjunct to conventional medicine. Instead, integrative medicine seeks to combine those modalities and treatments, including the science and technology of conventional cancer medicine and the holistic approach of complementary medicine, in attempts to meet a patient’s unique and individualized needs for healing. Lastly, and ideally, a fully integrated medical approach encourages the development of relationships between health care providers, whether CAM or traditional practitioners, so as to provide patients with individualized, coordinated and team-oriented care. |
