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Complementary and alternative medicines in oncology.

The use of complementary and alternative medicines (CAM) is widespread. In South Africa it has been found that 30-80% of patients attending oncology clinics use CAM. This cannot be ignored, and the topic should be discussed with patients in an appropriate manner. Whereas the use of many CAM may be seen as medically harmless, this view does not hold for all CAM, and harm can be caused to patients. In recent years the use of CAM has become an accepted fact internationally, to the extent that the National Institute of Health of the United States has a National Center for Complementary and Alternative Medicine (NCCAM), and many medical schools have CAM departments. The mission of the NCCAM is to 'support rigorous research on CAM, to train researchers in CAM, and to disseminate information to the public and professionals on which CAM modalities work, which do not, and why'.

Definitions

The term CAM is generally regarded as encompassing a group of healing philosophies, diagnostic approaches, and interventions that do not belong to the politically dominant (conventional) health system of a particular society. Some authors separate CAM into 'alternative' therapies used instead of conventional therapy, and 'complementary' therapies that are combined with conventional therapy. It has been said that 'alternative medicine' has become the politically correct term for questionable practices formerly labelled quack and fraudulent. To avoid confusion, CAM should be classified as genuine, experimental, or questionable. Genuine alternatives have met science-based criteria for safety and effectiveness. Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. Questionable alternatives are groundless and lack a scientifically plausible rationale. Ideally the term CAM should not exist. There should only be scientifically proven, evidence-based medicine or unproven medicine, for which scientific evidence is lacking.

A more recent trend is for some medical practitioners to offer 'integrative' medicine, a combination of conventional and alternative medicine. It is claimed that integrative medicine provides the best of both approaches. This of course is nonsense, and such an approach would be laughed at if applied to other scientific disciplines. Biologists would 'integrate' creationism with Darwinian evolution; chemists would 'integrate' alchemy into modern scientific chemistry; geologists would 'integrate' the belief that the world is only 6 000 years old (and flat) with modern dating of rocks; physicists would 'integrate' perpetual motion machines with the conservation of energy and the laws of thermodynamics; and astronomers would 'integrate' astrology and astronomy. Of course, this is ridiculous. It's not a good idea to integrate unproven theory or beliefs with valid scientific knowledge.

Dangers of unproven medicine

Unproven therapies can be harmful in a number of ways:

* economic cost: millions of rands are spent annually in South Africa on therapies of no proven value, often by people who cannot afford to do so, but are driven by a desperate need.

* direct harm: a number of so-called 'natural' remedies are in fact toxic, and may result in physical harm; a number of studies have associated the use of CAM with worse quality of life and shorter survival; CAM may result in multiple drug interactions, leading to decreased efficacy or increased toxicity.

* Indirect harm: the use of CAM may cause failure or delay in obtaining effective therapy, turning the curable into the incurable and resulting in premature death.

* Psychological harm: By offering false hope, quackery steals the most precious thing terminal patients have--time. The belief that patients have nothing to lose by using CAM is very wrong. Most people faced with a terminal disease can make a reasonable psychological adjustment to the fact, and use their remaining time wisely. Quacks discourage people from making this difficult adjustment by reinforcing their denial. Such people usually die unprepared because preparation for death is an admission of failure.

The South African context

When diagnosed with cancer, patients are faced with an onslaught of unproven CAM products forced upon them by well-meaning people and unscrupulous quacks. Products ranging from vitamins to fight the cancer (no proven benefit, and cancer cells may also benefit from vitamins), antioxidants (shown to be ineffective or detrimental), various immune boosters (no proven value), and a variety of off-the-wall therapies such as insulin potentiation therapy, ozone therapy, oxygen infusion therapy and electromagnetic treatment, are on offer. Practitioners should be familiar with the current CAM fashions and should be able to discuss these in some detail with patients and family. The use of unproven therapies should be discouraged and the use of complementary drug therapies together with proven therapy avoided, due to potential drug interactions. Patients should be provided with access to objective information about CAM (see Further Reading).

Further Reading

Basch EM, Ulbricht CE. Complementary, alternative, and integrative therapies in cancer care. In: De Vita VI, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology, 7th ed. Philadelphia: Lippincott, 2005. Casselith R, Vickers A. Complementary and Alternative Cancer Therapies. In: Kurfe UI, Pollock RE, Weichselbaum RR, et al. eds. Cancer Medicine, 6th ed. Hamilton: BC Decker, 2003. National Council Against Health Fraud: http:// www.ncahf.org Quackwatch: http://www.quackwatch.com

COENRAAD SLABBER, BSc, MB BCh, FCP(SA)

Medical Oncologist, Mary Potter Oncology Centre, Pretoria
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Title Annotation:More about... Update on cancer management
Author:Slabber, Coenraad
Publication:CME: Your SA Journal of CPD
Article Type:Report
Geographic Code:6SOUT
Date:Feb 1, 2007
Words:855
Previous Article:Targeted therapy in cancer in the 21st century.
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