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Integrative medicine: combining conventional with complementary to improve patient care.

Oncology nurses are frequently approached by their patients for advice and guidance, but some questions can be trickier than others. What do you tell your patients when they ask about acupuncture as a treatment for nausea? Or if they want more information about reflexology or Reiki for anxiety?

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Typically, most oncology nurses administer treatments and manage symptoms established by conventional medical standards. Theses interventions can make a difference for patients, both in terms of comfort as well as survival. Yet 44%-76% of cancer survivors report seeking treatments outside of conventional medicine (Fouladbakhsh, 2010). So, what should an oncology nurse know about use of these often unusual and unfamiliar practices?

What Is Integrative Medicine?

"Integrative medicine incorporates the best of two complex worlds of health care: conventional medicine and complementary and alternative medicine (CAM) to holistically meet patients' health needs," ONS member Judith M. Fouladbakhsh, PhD, APRN-BC, AHN-BC, CHTP, assistant professor at Wayne State University's College of Nursing, explains. "CAM includes a vast number of practices and products, many of which originated within alternative medical systems such as traditional Chinese and Ayuvedic medicines. Today, many therapies from CAM are being included within conventional medicine settings, allowing for a more holistic approach to patient care. Integrative medicine thus chooses the best therapies and practices from the CAM world for inclusion with conventional care."

ONS member Georgia M. Decker, APRN, ANP-BC, OCN[R], AOCN[R], nurse practitioner at Integrative Care in Albany, NY, summarizes that integrative medicine is simply "medical care that integrates evidence-based conventional medicine with evidence-based complementary therapies."

Common CAM Myths Debunked

Myth: CAM therapies used in integrative medicine are not evidence-based.

Truth: According to Fouladbakhsh, CAM therapies cannot be quickly dismissed on this basis. "CAM is not a simple treatment or approach. Rather, it is a complex world of health care that includes many different whole systems of care and many different therapies and approaches. These may be culturally or spiritually based, often integrating the body, mind, and spirit. Hence, we cannot simply say CAM therapies are not evidenced-based. We must look at the specific therapy in question and seek information on the scientific evidence."

Decker adds, "We have made great strides in identifying those for which there is evidence and those for which there is no evidence."

Myth: Natural = safe.

Truth: Understandably, many patients may be enticed to use therapies that are labeled "natural" or are available without a prescription. "Just because something is 'natural' does not make it safe. 'Natural' products can and do interact with other herbs, supplements and drugs that are over the counter and those that are prescribed," Decker stresses.

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Fouladbakhsh voices a similar concern that natural therapies require vigilance: "Herbs and supplements work much differently than pharmaceutical agents, which I feel many patients do not understand." Interestingly, she also reports that some patients believe that herbs "are dangerous, often more so than pharmaceuticals. The vast number of herbs available across the world, as well as factors such as standardization, source, and product type, and the hazards of generalization when such variation exists," furthers confusion about the use of herbs as a treatment within integrative care.

Myth: Massage can spread cancer.

Truth: Multiple studies have concluded that the use of massage can improve pain and relieve symptoms, yet patients can express concerns that massage will metastasize their cancer.

"The scientific evidence for massage is extensive," Fouladbakhsh says. "Risks with massage can include skin irritation, slight soreness, and unexpected emotional release. This can be a good thing; however, client and practitioner need to be able to handle this situation."

Although massage appears to have few risks, the National Center for Complementary and Alternative Medicine cautions about the use of massage in patients who are taking anticoagulants, are experiencing thrombocytopenia, or are pregnant.

Appropriate Uses

Combining low-risk, evidence-based CAM with conventional medicine sounds like a great idea, but some factors need to be considered with use of integrative therapies. Integrative therapies may be ill-advised when "the complementary therapy practitioner is not properly credentialed or when the patient does not report to their healthcare provider all supplements, herbs, or other therapies they may be taking," Decker says. "The Internet is fraught with misinformation and claims of scientific evidence when there is none. Beware of any therapy or natural product that claims to treat or cure specific diseases and conditions or encourages a person to keep it a secret from their healthcare provider."

Fouladbakhsh considers integrative therapies as always advisable. "As an advanced practice holistic nurse, I would say that an integrative, holistic approach is always indicated. I believe that the body-mind-spirit should be our focus in all situations. What is critical, of course, is the assessment and prioritizing of what requires attention first, followed by a comprehensive approach addressing all needs."

The Future of Integrative Care

Use of integrative medicine is increasing; National Cancer Institute--designated cancer centers such as Memorial-Sloan Kettering, M.D. Anderson, Johns Hopkins, and Dana-Farber now have formal integrative medicine programs, and the availability of integrative providers continues to grow.

Fouladbakhsh encourages oncology nurses to follow a few basic ideas when caring for patients in the integrative setting: "Respect patient choices, and avoid being judgmental; recognize the value of these therapies to the patient and their family; understand the individual's cultural, spiritual, and philosophical aspects; assess the patient's use of these therapies; and guide them to appropriate sources for care."

"Integrative medicine is gaining in popularity and is the future," Decker says. "It is essential for oncology nurses to familiarize themselves with the ONS position on these therapies and to utilize the print and online resources available through ONS."

Fouladbakhsh, J.M. (2010). Use of complementary and alternative medicine (CAM) providers, practices, and products among U.S. cancer survivors. Proceedings of the 5th International Congress on Complementary Medicine Research, Trumso, Norway. Retrieved from http://www.iccmr2010.com/Media/Files/ICCMR-2010-Abstract-Book-Revised-Edition

RELATED ARTICLE: Society of Integrative Oncology Offers Practice Guidelines for Integrative Medicine

The Society of Integrative Oncology (SIO) is a nonprofit, multidisciplinary organization dedicated to the study of cancer treatment and recovery from cancer with the inclusion of integrative medicine and therapeutic options.

SIO's practice guidelines are formulated from the research that is available and graded based on the strength of the research. They are grouped into seven categories: the clinical encounter, mind-body modalities, touch therapies, fitness, energy therapies, acupuncture, and diet and nutritional supplements.

Two recommendations in the clinical encounter are to routinely ask patients about complementary and alternative therapies at the initial visit and to provide guidance to patients about the benefits and limitations of complementary therapies.

For more information, visit www.integrativeonc.org/index.php/sio-publishes-2009-practice-guidelines.

Key Terms

Alternative medicine refers to the exclusive use of nontraditional interventions in lieu of mainstream medicine.

Complementary and alternative medicine (CAM) refers to a diverse group of practices and therapies not considered to be part of mainstream medicine. Common examples include dietary supplements, meditation, acupuncture, tai chi, and chiropractic manipulation.

Complementary medicine refers to CAM practices used in conjunction with mainstream medicine. These practices are intended to supplement, enhance, or complement therapies used by traditional medicine.

Integrative medicine refers to a systematic use of all appropriate practices, conventional as well as alternative, in a manner that focuses on the whole person.

[By Heather McCreery, RN, MBA, OCN[R], CCRC, Contributing Editor]

Contributing Editor Heather McCreery, RN, MBA, OCN[R], CCRC, is a clinical research coordinator faculty member at Northwest Vista College and a nursing house supervisor at Christus Santa Rosa Hospital in San Antonio, TX.

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Author:McCreery, Heather
Publication:ONS Connect
Geographic Code:1USA
Date:Nov 1, 2010
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