Knowledge of and attitudes toward complementary and alternative therapies; a national multicentre study of oncology professionals in Norway.

This study reports on oncology professionals' knowledge and attitude toward complementary and alternative medicines (CAM), classified according to their primary application as complementary or alternative methods. In June 2002, we conducted a national, multicentre survey of 828 Norwegian oncologists, nurses, clerks and therapeutic radiographers. A response rate of 61% was achieved. Only a few physicians (4%) described their reactions to alternative medicine as positive compared with nurses (33%), therapeutic radiographers (32%) and clerks (55%) (P<0.0001). Females showed a more positive view than males (33% versus 14%, P<0.0001). More participants expressed a positive attitude to complementary versus alternative medicines. Most respondents regarded healing by hand or prayer, homeopathy, and Iscador (mistletoe) as alternative therapies. In contrast, most respondents classified acupuncture, meditation, reflexology, music/art-therapy, aromatherapy and massage as complementary therapies. This survey demonstrates major differences, by gender as well as oncology health profession in views about and the classification of various CAM methods.

Does use of alternative medicine predict survival from cancer?

This study examines the association between alternative medicines (AM) and cancer survival. A national multicentre study was carried out in Norway in December 1992 to assess the prevalence of AM use among cancer patients. One of the aims of this study was to assess the association between AM and long-time survival. In January 2001, survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 (22%) assessable patients used AM. During the follow-up period, 350 patients died. Death rates were higher in AM users (79%) than in those who did not use AM (65%). In a Cox regression model adjusted for demographic, disease and treatment factors, the hazard ratio of death for any use of AM compared with no use was 1.30, (95% Confidence Interval (CI) 0.99, 1.70; P=0.056), suggesting that AM use may predict a shorter survival. Sensitivity analyses strengthened the negative association between AM use and survival. AM use had the most detrimental effect in patients with an ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 (hazard ratio for use=2.32, 95% CI, 1.44, 3.74, P=0.001), when compared with an ECOG PS of 1 or higher. The use of AM seems to predict a shorter survival from cancer. The effect appears predominantly in patients with a good PS.

Alternative medicine use worldwide: the International Union Against Cancer survey.

BACKGROUND: In the current study, the authors attempted to surmount the deficiencies of previous surveys and elicit information regarding the use of alternative treatments of cancer worldwide. METHODS: The International Union Against Cancer (UICC), an international, nongovernment volunteer organization, E-mailed a questionnaire concerning alternative therapy use to its members. RESULTS: A total of 83 responses from 33 countries were received. Descriptive analyses of this dataset were conducted, indicating the existence of a large and heterogeneous group of unproved remedies used to treat cancer in both developed and developing countries around the world. CONCLUSIONS: Improved public education concerning the importance of early medical attention and the value of documented cancer therapies, the wider availability of useful cancer treatments, and public policies that are sensitive to the patient's need to play a meaningful role in his or her own care are required.

Unconventional therapies for cancer and cancer-related symptoms.

A significant proportion of cancer patients try unconventional therapies and many use 'complementary' therapies, as adjuncts to mainstream care, for management of symptoms and to improve quality of life. A smaller proportion use 'alternative' therapies, which are typically invasive, biologically active, and commonly promoted as replacements for, rather than adjuncts to, mainstream therapy. Many alternative therapies, including high-dose vitamin C, the Di Bella regimen, and laetrile have been shown not to be effective. For others, such as metabolic therapy, evidence is extremely limited. Conversely, most complementary therapies are well studied and of proven benefit. There is evidence from randomised trials supporting the value of hypnosis for cancer pain and nausea; relaxation therapy, music therapy, and massage for anxiety; and acupuncture for nausea. Such complementary therapies are increasingly provided at mainstream cancer centres.

Complementary therapies: the American experience.

This article explains the difference between complementary and alternative medicine and describes the current levels of use of such therapies in the United States of America, particularly among cancer patients. The complementary therapies that can help cancer patients during treatment for their disease and during rehabilitation are treated in greater depth.

Holistic pediatrics: a research agenda.

Increasing numbers of American families seek complementary and alternative medical care (CAM) for their children; at the same time health care organization and financing are undergoing radical changes. The combination of these factors provides a powerful incentive for research on the effectiveness and safety of CAM therapies and their role in treating children. This article describes a rationale, spectrum, priorities, and methodologies for a research agenda in holistic pediatrics. The top priorities are clinical research projects addressing the safety and effectiveness of alternative therapies used for vulnerable children suffering from serious illnesses. Additionally, major research questions involve the impact of the various definitions such as "alternative," "complementary," "folk," "integrative," and "holistic" medicine on perceptions of health care, professional education, and funding of products and services. Research efforts in alternative therapies need to address explicitly the tremendous heterogeneity between and among the practices, beliefs, and providers of professional and lay services. Qualitative ethnographic research is needed to understand the consequences of diverse explanatory models and meanings of health and illness for patient-provider communication, adherence with professional recommendations, and satisfaction with care. Health services researchers need to address questions related to the epidemiology of CAM practices, health manpower issues, practice characteristics and the process and content of health care and how discoveries about CAM care may enhance the quality of mainstream health services. A rationale is provided for prioritizing certain conditions and therapies within these efforts.

Complementary therapies: overview and state of the art.

Studies to determine the prevalence of complementary and alternative medicine (CAM) use among cancer patients show international interest in a wide collection of therapies and a broad span of use, ranging from 7% to 64% of patients sampled. The absence of consistent results across studies is due primarily to differing definitions of unconventional cancer therapies from study to study. Treatments promoted as alternatives to mainstream cancer cures (e.g., the recently disproved "cancer cure" of Italy's Dr. Di Bella) should be distinguished from complementary therapies, which are applied as adjuncts to mainstream care in an integrated fashion. The latter include mind-body techniques and herbal remedies, among many other remedies, all aimed at symptom control and enhanced quality of life. This differentiation provides a clearer understanding of CAM activity and enables selective evaluation of CAM's clinical effects. It permits us to avoid accepting or rejecting all of CAM out of hand. Health care professionals as well as patients and their families have become increasingly knowledgeable about complementary therapies that can be helpful to patients with cancer. Many such therapies have been well studied (meditation, tai chi), and others remain highly questionable (homeopathy, electromagnetics). Their benefits and potential problems are reviewed.

Evaluating complementary and alternative therapies for cancer patients.

"Complementary and alternative" therapies are actually a vast collection of disparate, unrelated regimens and products, ranging from adjunctive modalities that effectively enhance quality of life and promising antitumor herbal remedies now under investigation, to bogus therapies that claim to cure cancer and that harm not only directly, but also indirectly by encouraging patients to avoid or postpone effective cancer care. Complementary therapies such as music and massage, herbal teas to aid digestion and relieve nausea, yoga, tai chi, meditation, and the many other well-documented techniques that relieve stress and enhance well-being should be made available to patients to augment and ease the experience of cancer treatment and recovery. Many time-tested herbal and diet-based remedies are now being studied for their abilities to induce or extend remission without toxicity. At the same time, lack of government regulatory authority leaves consumers at the mercy of those who promote unproved remedies, scores of which the grocery store and pharmacy shelves. Many of these over-the-counter products contain harmful ingredients. Herb-drug interactions, only some of which are documented, occur with frequency and are sufficiently problematic to require that patients stop taking herbal remedies prior to surgery (to prevent interactions with anesthetics and anticoagulant effects); before radiation (due to potential for increased photosensitivity); and during courses of chemotherapy (to prevent product-drug interactions). Moreover, both good information and misinformation that appear in printed materials and on the Internet appeal to better educated consumers, who are, in fact, the most likely to try complementary and alternative methods.

How useful are unconventional cancer treatments?

Unconventional cancer treatments are used frequently. Therefore, oncologists need to know about them. This article gives an overview of current knowledge on the most prevalent complementary or alternative cancer therapies. A distinction is made between alleged cures, preventive and adjunctive measures. Shark cartilage, mistletoe, thymus therapy, essiac, hydrazine sulphate, 714-X, dietary regimens, green tea and Panax ginseng are all covered specifically. None of these treatments offer reasonable hope for a cure. Some strategies are promising in terms of cancer prevention. The true potential of unconventional therapies might lie in adjunctive and palliative care. It is concluded that good evidence in this area is scarce. Vis-à-vis the high prevalence of unconventional cancer treatments, rigorous investigations are mandatory, not least for increasing the safety of future patients.

The prevalence of complementary/alternative medicine in cancer: a systematic review.

BACKGROUND: Complementary/alternative cancer treatments are believed to be prevalent. However, reliable prevalence rates do not exist. The aim of this review was to summarize the existing data on this topic. METHODS: A series of computerized literature searches was performed to locate all published studies documenting the prevalence of complementary and/or alternative therapy (CAM) use among patients with cancer. RESULTS: A total of 26 surveys from 13 countries, including 4 studies of pediatric patients, was retrieved. The use of CAM therapies in adult populations ranged from 7-64%. The average prevalence across all adult studies was 31.4%. CONCLUSIONS: This large degree of variability most likely is due to different understandings of "complementary/alternative medicine" on the part of both investigators and patients. It is likely that the results of the current study reflect the primarily adjunctive use of CAM treatments. Future studies should use a standardized protocol to determine the true prevalence of these therapies more closely.

How should we research unconventional therapies? A panel report from the Conference on Complementary and Alternative Medicine Research Methodology, National Institutes of Health.

Research in unconventional medicine requires a number of different questions to build up a "mosaic" of evidence. Choice of research design depends on the question being asked and is independent of the therapy under investigation. Despite the doubts of some practitioners, randomized trials are of value for determining certain questions in alternative medicine.