An evidence-based systematic review of complementary and alternative medicine (CAM): Recommendations concerning the efficacy and safety of popular CAMs used by cancer patients. Part II. The best of the best in integrative cancer care (#20)
Aims: Complementary medicine is used by 14-65% of Australian adult cancer patients, and alternative medicine by 8-14%. It is therefore important that clinicians have a good understanding of the evidence available for the efficacy and safety of CAMs. Consequently, a systematic review was performed to evaluate the efficacy and safety of over 50 individual CAMs.1
Methods: Multiple electronic databases/sources were searched up to August 2012. Nearly 400 publications were utilised, including over 300 meta-analytic/systematic reviews.
Results: Some complementary therapies (e.g. relaxation) are beneficial in reducing disease/treatment symptoms and improving quality of life/psychological functioning, and in years to come may be integrated into everyday clinical practice. In contrast, nutritional supplements and herbal medicines may pose direct safety risks due to adverse effects/interactions with conventional anticancer treatments and other medications. While some should not be used by cancer patients under any circumstances irrespective of benefit (e.g. St. John’s wort), evidence suggests that others are beneficial and safe under medical supervision (e.g. valerian). The latter will be of primary focus in this review.
Conclusions: Integrative cancer care is a patient-centred approach that nurtures the physical/emotional/spiritual well-being of cancer patients by integrating safe, evidence-based complementary therapies with conventional anticancer treatments. Research indicates that 33-77% of patients, however, do not disclose CAM use to their physicians, and that CAMs are problematically perceived as more “natural” and safer than conventional treatments. Indeed, they may pose direct safety risks, and more research is required to evaluate/confirm the efficacy and safety of many CAMs. It is therefore imperative that those involved in the medical care of cancer patients are equipped with the skills and knowledge to help patients appropriately evaluate CAMs, in order to receive benefit while avoiding harm. Additionally, clinicians are strongly encouraged to routinely ask patients about CAM use. Offering evidence-based complementary therapies (or at least safe forms of them) alongside conventional treatments can influence patients’ decisions to continue with mainstream care, and help avoid any potential harm that may occur with autonomous CAM use.
- Pirri C. (2012). Complementary and alternative medicine used by patients with cancer: Evidence for efficacy and safety (Chapter 3). In: Olver IN, Robotin MC. (eds.), Perspectives on complementary and alternative medicines. London: Imperial College Press.