Is Complementary and Alternative Medicine Safe and Effective in Palliative Care - Literature review Example

?Is complementary and alternative medicine safe and effective in palliative care? Introduction Repeated changes have been made to palliative therapy terms not commonly included in mainstream medicine. These terms have evolved from being quackery to unorthodox, unconventional and unproven. Current terminology is in favour of “complementary and alternative medicine” with an acronym as CAM. This shifting of the terminology led to the creation of the National Institute of Health Office of Alternative Medicine which in 1999 was renamed to National Centre for Complementary and Alternative medicine (NCCAM) (Cassileth and Deng, 2003). Complementary and Alternative Medicine (CAM) Since 1999, there has been long promotion of this form of therapy. Complementary therapies are used to supplement mainstream cancer care. These are supportive measures to control symptoms, enhance well being and contribute overall palliative care. On the other hand, Alternative therapies are those promoted for use as a substitute of the mainstream treatment. This type of therapy have raised controversy in oncology arguing delayed treatment diminish remission and cure possibilities. Moreover, arguments exists that interventions said to be alternatives to chemotherapy, surgery and radiation therapy are biologically active. Therefore, they are potentially harmful and very costly .Over time, some complementary therapies have proven to be safe and effective; such therapies have become integrated into mainstream care. Such adjuncts to mainstream care produce integrative oncology resulting to the synthesis of the best mainstream cancer treatment that is not only rational but data based and adjunctive complementary (Werneke et al, 2004). . Types of CAM NCCAM currently classifies CAM therapies into five categories: alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body based methods and energy therapies. Traditional medical systems are developed by ancient cultures; Examples include traditional Chinese Medicine (TCM), India ayurvedic medicine, homeopathy and naturopathic medicine. TMS practice lays emphasis on working with the internal natural forces to reach a harmonic state of mind and body. The disadvantage of this type of CAM is that the assumptions concerning human physiology and disease are inconsistent with scientific understanding which may deteriorate the condition. For instance, TCM view people as miniature ecosystems. It argues that any imbalance between opposing forces is the root cause of illness. The therapy emphasizes on maintaining balance and the flow of life elements for restoration of health. Ayurveda term is derived from Sanskrit words ayur (life) and ved (knowledge). It is an ancient technique based on classification of people into groups. The therapy has specific remedies for diseases. It also stresses on the strong mind body component to maintain consciousness in balance. Secondly, Mind and body interventions which is categorised amongst the most beneficial complementary therapy. It utilizes the reciprocal relationship between body and mind. This way, it helps the patient to relax and reduces stress associated with cancer treatments. Examples include Hypnosis and relaxation technique often given by conventional practitioners. Music therapy offered by trained music therapists has been found to be very effective in palliative care because it alienates anxiety, depression and pain. Massage also is said to be effective especially for palliative care patients. Research finding shows that massage facilitate in the reduction of anxiety, fatigue and nausea. Other therapies under this category include Acupuncture and moxibustion (Cassileth and Deng, 2003). Biologically based therapies are highly controversial. One of such treatment is the Stanislaw Burzynski used in Houston Clinic, Texas. However, joint research by NIH Office of alternative Medicine and NCI showed no positive outcome. Another technique is Immuno-augumentation therapy (IAT) which involves subcutaneous injections of sera derived from healthy individuals to treat mesothelioma. However, IAT’S efficacy remains anecdotal. Many other unproven methods biological treatment methods includes use of shark cartilage as a cancer therapy, Laetrile, oxygen and ozone therapy, insulin, bioresonance therapy and many other. Lastly is the Energy therapies believes in existence of energy fields surrounding the human body. Therefore changes on the purported energy field via manual manipulations such as application of electromagnetic fields, the disease is eliminated. This is not scientifically proven (Cassileth and Deng, 2003). Herbal medicine Cancer patients have been found to rely mainly on the counter dietary supplements. Data obtained form Women’s Healthy Eating and Living survey indicated that up to 80% of non-stage IV breast cancer patients took dietary supplements including vitamins, antioxidants and herbs. Moreover, there has been increased use of herbal products in the recent years. Herbal medicine consists of natural drugs containing different chemicals that have not been documented. Their effects are not predictable. More so, the FDA and other agencies meant to examine drugs on human safety hardly examine herbal drugs for their safety and effectiveness. Therefore, patients opting to take herbal medication need to be advised appropriately on the possible health complications due to interactions and chemotherapeutic agents. Such complications include blood pressure swings, and other unwanted interactions with anaesthetic agents during surgery. Furthermore, there exist concerns raised regarding dietary antioxidants. There lies possibility that they may interact with radiation therapy or chemotherapeutic agents especially for patients with renal failure (Cassileth and Deng, 2003). Examples of herbal remedy include Essiac. It is one of the most popular herbal remedies for treating cancer in North America. Its origin roots from South-western Canada. It comprises four herbs namely burdock, turkey rhubarb, sorrel and slippery elm. Iscador is another popular herbal remedy for treating cancer used in Europe. It is available in most of mainstream European Cancer clinics. Studies done on the effectiveness of this remedy have mixed findings. Other herbal remedy components include the Mush room derived compounds such as Polysaccharide Kureha (PSK). This is an extract of Coriolus Versicolor mushroom used for colorectal cancer (Cassileth and Deng, 2003). Therefore, use of CAM and herbal remedies has negative consequences. For instance, unconventional cancer therapies such as Laetrile, Essiac and coenzyme Q10 are ineffective. Additionally, they pose dangerous side effects especially with conventional treatment. For example, garlic and cod liver oil have anticoagulant effect. St John wort remedy used to treat cytochrome P450 system interacts with hormones and other antibiotics and chemotherapeutic agents (Werneke et al, 2004). Palliative care Palliative care refers to the active overall care to patients at their bed stage of terminal cancer cases. It is provided by community health workers, physicians and nurses with the aim of providing comfort and relief to the patient. They do so by addressing their physical, emotional, social and spiritual hardships arising during the period. Community health workers also train care givers and family member’s strategies on ways to assist to control pain and symptoms. The major goal for palliative care is to attain the best possible quality of life to the patients. The principles of palliative care entail providing emotional, social and spiritual support to the patient. Terminal cancer makes patient feel isolated and depressed. Such emotions affect the patient negatively affecting their ability to deal with pain. Secondly, the palliative care helps the patient to manage pain and symptoms by exercising few things to help keep the patient comfortable. The care provides practical and emotional support to care givers to help them deal with the patient. It also offers additional support by ensuring that caregivers have access to all requirements, understand the disease as it progresses and train them on how to administer proper medication to ease the load. Lastly, the patient and relatives are prepared for death with dignity. They informed honestly about how the disease progresses to its last days helping them grief with the palliative care worker (Cancer Council, 2008) Measure of CAM safety and effectiveness of treatment in palliative care The use of CAM for palliative care is widespread. Statistics reveals that more than 60% of cancer patients have at one time used CAM. According to Datamonitor 2002 survey, 80% of cancer patients have used either alternative or complementary modality. Additionally, virtual studies done to date indicate that cancer patients who seek CAM therapies are those educated, of higher socioeconomic status than those who do not. Additionally, they tend to be healthier conscious and utilize more mainstream medical services as compared to those who do not use CAM therapy. Recent years have shown some increase in CAM use by cancer patients during their. Recent surveys shows that most common used therapies include spiritual healing or prayer standing at 13.7%, herbal medicine 9.6% and 7.6% representing Chiropractic therapies. Although some instances showed that use of CAM as an indicator of greater psychological distress and poor lifestyle, patients claim that use of CAM improve their psychological and psychosocial well being because of the valued closer relationship with CAM practitioner and their will to control and have greater responsibility for self –care (Cassileth and Deng, 2003). Evidently, there is high prevalence of herbal medicine and supplement use in palliative care of cancer patients. Additionally, substantial proportion of patients use herbal remedies that pose potential threat to their health and especially so during drug interactions. Despite the fact that most patients discuss their CAM therapy with their health care professionals, there is still a considerable potential threat to the patient’s fitness. This is because medical practitioners are inadequately acquainted as required to deal with the large number of potential risks or lack time to do routine check ups during the out patient clinics. Besides, patients are reluctant to embrace doctor’s opinion regarding their health arguing that conventional cancer treatment is equally noxious (Werneke, 2004). This calls for more education to the cancer patients on the benefits of CAMs and their risk management. For example, it is of patients benefit to learn that some vitamins are only effective when consumed in fruits and vegetables but are ineffective as supplements. They should be educated on the potential risks involved when CAM interacts with drugs and other chemo- pharmaceutical products during diagnostic procedures. For example, Kelp interacts with contrast agents that contain iodine often used in bone and thyroid scanning. This causes antioxidants binding of free radicals increasing photosensitivity and may interfere with radiotherapy (Werneke, 2004). Clinicians also need to be conscious of CAM- induced side effects and interactions for identification of hazards. They should also advice the patients accordingly to circumvent uncritical encouragement to potentially harmful use. Moreover, patients should be encouraged to disclose information about CAMs to practitioners. Considering a third of herbal remedies have psychotropic effects, psychological needs by CAM users should be adequately explored. Research on cams and their interactions with conventional medicine should be conducted to keep pace with the innovation of new cancer therapies. Also, doctors should devote their time to discuss CAM use, the possible complexities of side effects and interactions to understand herbal formularies. Lastly, pharmacists have a major role to update physician’s important information obtained from patients and other health care professionals (Werneke, 2004). Literature review Many cancer patients under CAMs therapy may not be aware of the potential risks. There exists limited information regarding quantification of such risks. According to cross-sectional survey of patients attending outpatient department at a cancer centre was carried out by Werneke and colleagues in 2004. From a total of 318 patients participating in the study, 164 (51.6%) were under CAMs. 10. 4 % utilized herbal remedies, 42.1% took only supplements and 47.6% were under combination of both. From the studies, health warnings were issued for cod liver/fish oil, garlic, beta-carotene, ginseng and evening primrose. The study concluded by urging the practitioners to understand clearly the potential risks (Werneke et al, 2004). Farooqui and colleagues in 2011 studied Malaysian oncology patients regard to the use of CAMs therapy to manage their care. Through interviews across three major Malaysian groups ethnic group namely Chinese, Indian and Malay, they found mixed reactions concerning the effectiveness of CAMs to treat cancer. The study indicated that effectiveness and safety of CAMs in cancer palliative care was the main reason given by the participants to decline CAMs therapy. Such patients argued that serious diseases such as cancer needed to be cured through proven scientific methods. Therefore, absence of Modern technology and methods of assessment were the major reasons for CAMs therapy rejection. More so, safety concerns were raised. These included the side effects. The research concluded that irrespective of popularity on CAMs therapy, it was adopted cautiously. Therefore, the levels and patterns of CAM were hard to estimate (Faroooqui et al, 2011). Akyol and Oz assessed the use of CAMs amongst 94 adult Turkish patients with cancer. These patients were selected from an outpatient clinic at the Adult oncology Department of the University of Izmir through filling in of questionnaire. Study findings indicated that most of Turkish Oncology patients in the study were under herbal remedies. The socio-demographic factors associated with CAMs remedies identified included gender, age, education background and economic status. Other factors include support from close friends, relatives and health care professionals. Additionally, patients said that their source of CAMs came from friends and the media. They used such therapy to reduce physical effects which arose from convectional mode of treatment. Trends of CAMs use in cancer patients in Turkey and Europe are similar standing at 36%. However, most frequently reasons behind CAMs remedy use in Turkey is to cure Cancer, relieve side effect that arose for convectional therapy, boost immune response and alleviate pain whilst in Europe , the primary reason is to increase the individual capability to fight cancer (Akyol and Oz, 2011). Evidently, more cancer patients are increasingly using complementary and alternative therapies. Oncologists should discuss the safety and effectiveness of CAM remedies. They should encourage open communication of CAM by their patients. Most importantly, they should broaden their knowledge regarding these remedies so that they can offer the patients reliable information. Also, questionable alternative therapies should be avoided. Most of unproven alternatives are promoted in a very appealing version. Therefore, brushing aside such topics will make a patient welcome such remedies with open arms. On the other hand, beneficial complentary and alternative medicines that manage pain, stress, depression and other disorder should be integrated in the medical mainstream to improve the quality of patient’s life (Werneke et al, 2004). Conclusion In summation, majority of cancer patients uses herbal essences and therapies to manage their treatment. The relationship between CAM use and advice obtained regarding the treatment is statistically insignificant. Therefore, future research should focus in quantifying health risks associated to CAMs therapy to improve standardization and knowledge regarding herbal- drug interactions and potential biasness for or against particular CAMs therapies. References Akyol. A. D., and Oz, B. (2011) The use of complementary and alternative medicine by patients with cancer: in Turkey. Complementary Therapies In clinical Practice 17 (2011) 230-234 Cancer council (2008) Understanding Complementary Therapies: A guide for people with cancer, their families and friends. Cancer council New South Wales ISBN 978-1-92-1041-80-8 Cassileth, B., and Deng, G. (2004). Complementary and alternative therapies for cancer. The oncologist Vol.9 No.1 80-89 Farooqui, M., et al (2011). Complementary and Alternative medicine (CAM) use by Malaysian Oncology patients. Complementary Therapies in Clinical Practice xxx (2011) Ie7 Werneke, U., et al. (2004) Potential health risks of complementary alternative medicines in cancer patients. British Journal of cancer (2004)90, 408-413 Read More