ALTERNATIVE AND COMPLEMENTARY MEDICINE GOING MAINSTREAM
While some treatments for hematologic conditions such as cancer and sickle cell disease (SCD) have been refined over time — increasing survival rates and decreasing side effects — patients with SCD frequently still suffer painful episodes resistant to existing treatment options, and those with cancer often feel worse while receiving chemotherapy, radiation, and other conventional therapies. These realities can make alternative treatments appealing options.
Complementary and alternative medicines predate Western medicines and persist in their appeal, and physicians are noticing their patients using some type of unconventional treatment with greater frequency — such as incorporating acupuncture into a treatment plan or forgoing conventional treatment altogether in favor of herbal supplements or other untested options they believe are more likely to cure their ills.
Despite the dangers of skipping traditional treatments for hematologic diseases, many health care providers believe that including at least some type of complementary medicine in a patients’ treatment plans may be desirable, and even beneficial.
Large cancer centers are opening what they call integrative or comprehensive centers that encourage patients to use some of the therapies that weren’t previously considered part of conventional therapy, under the supervision of physicians and in conjunction with traditional methods. Health care professionals and patients hope that the therapies will mitigate symptoms or side effects of conventional treatments.
Moreover, some clinicians hope that acknowledging the value of these methods will deter patients from skipping treatment in favor of dangerous alternatives.
“The worst thing that we can do as providers is create an environment where patients don’t feel safe talking to us about what they’re interested in trying to treat their cancers,” Skyler Johnson, MD, an oncologist at Yale University School of Medicine who studies cancer outcomes. “There’s a chance that they will do it anyway, unbeknown to us.”
Alternative, Complementary, Integrative
Any health care approach that is not typically part of conventional treatment or has origins outside of Western practice could be considered alternative or complementary medicine. The distinction comes with the relationship to standard treatments, according to the National Institutes of Health’s (NIH’s) National Center for Complementary and Integrative Health (NCCIH).
If a nonmainstream practice is used together with conventional medicine, it’s considered complementary. If a nonmainstream practice is used in place of conventional medicine, it’s considered an alternative healthcare treatment.
According to a 2018 survey by the American Society of Clinical Oncology, nearly 45% of people in the U.S. believe that cancer can be cured by alternative therapies alone. This belief can be deadly: Patients who forgo conventional cancer treatment and opt only for alternative treatments are 2.4 times more likely to die from the disease. Alternative therapies, often marketed as “cancer cures,” can include unproven treatments such as baking soda infusions, oxygen therapy, intravenous vitamin C infusions and herbal supplements.
Still, more and more scientists are encouraging research into certain types of therapies that fall outside of conventional disease treatment — such as yoga, massage, meditation, and mindfulness. These modalities can be helpful when incorporated into interdisciplinary treatment plans, in conjunction with traditional methods, they argue.
This type of interdisciplinary approach, which brings together conventional and complementary therapies, is referred to as integrative medicine. It emphasizes a holistic, patient-focused method of care by addressing the mental, emotional, functional, spiritual, social, and community aspects of a patient’s well-being. Doctors who practice integrative care work to understand how yoga, acupuncture, and other techniques could mitigate side effects and increase patients’ quality of life, while ensuring that people also receive conventional therapies to cure or manage their disease.
Alternative medicines, offered by doctors, naturopaths, or even people with no medical experience at all, have always been available. Desperate patients disappointed by the risk-benefit profiles of current treatments or who distrust conventional medicine have sought them out in hopes of curing cancers and other diseases. Today, the internet and social media can make finding information about diseases and treatments both faster and more confusing than ever.
Like Dr. Johnson, many patients and family members scour the internet before or during treatment. Some might find resources from reputable sources like the National Cancer Institute or large health care organizations; others might stumble upon alternative sources that are just as convincing, but with contradictory advice to forgo conventional therapy.
From Quackery to Complementary
David S. Rosenthal, MD, a hematologist at the Dana-Farber Cancer Institute, was deeply involved with integrative and alternative medicine in the early 1970s, when the American Medical Association appointed him to its Committee on Quackery. Times have changed since the mid-1970s, when the committee was disbanded, and a growing number of doctors are tentatively getting on board with addressing — and sometimes even offering — complementary and integrative therapies for their patients.
He and his group at the Zakim Center began exploring complementary therapies back in 2000, starting with acupuncture and massage. The center offers these treatments to patients with cancer, as well as reiki, art therapy, meditation, yoga, exercise, and nutritional counseling. These methods “can help patients feel better by reducing the pain, stress, and anxiety caused by cancer and its treatment.”
Many other large treatment centers have developed similar departments to support patients who are interested in trying these therapies in conjunction with conventional treatment: The University of Arizona’s Andrew Weil Center for Integrative Medicine has been training physicians in integrative approaches to care for 25 years; and the Memorial Sloan Kettering Cancer Center operates the Bendheim Integrative Medicine Center.
In addition to treatment centers working to fund and provide integrative treatments, the National Cancer Institute (NCI) opened the Office of Cancer Complementary and Alternative Medicine (OCCAM) in 1998. The program offers grants to study complementary treatments and highlights the results on its website. However, many researchers contend that funding for research on complementary medicine is still lacking.
While encouraging conversations and offering certain integrative therapies may prevent some patients from engaging in dangerous alternative options and forgoing treatment, there are still questions about who uses complementary medicine and how it affects their other care decisions, Dr. Johnson noted. He recently conducted a study to identify characteristics that make patients with cancer more likely to pursue complementary medicine — and whether use of these therapies affects adherence to conventional treatments or has any effect on survival.
He added that the question of “whether including integrative specialists in these conversations actually can modify behavior in patients who are interested in alternative therapies is fascinating and needs to be studied further.”
Natural Does Not Always Mean Safe
Most, if not all groups that offer complementary medicine endorse mind-body methods such as acupuncture, massage, tai chi, and meditation. These options are less controversial, and possibly less likely to be mistaken for a treatment that can replace conventional therapies.
Acupuncture is one of the most researched forms of complementary medicine, with studies suggesting it can be useful for managing pain, neuropathy, anxiety, and nausea — symptoms commonly experienced during cancer treatment.
While doctors are more likely to recommend mind-body treatments like yoga and acupuncture as complementary treatments, a small 2015 survey of German patients and physicians suggested that patients were less enthusiastic about these options and showed far more interest in biological interventions such as vitamins, supplements, and herbs.
Another challenge is that patients sometimes disagree with their physicians on the value of certain complementary medicines, according to Kenneth Adler, MD, who is co-liaison to the ASH Committee on Practice from the ASH Practice Partnership. In these instances, said Dr. Adler, a hematologist and oncologist at the Summit Medical Group in New Jersey, his best option is to enlist other doctors in the discussions. He will refer his patient to a “reasonable physician who offers opinions about complementary medicine,” as well as another conventional doctor.
Working Outside the Box
Patients can easily access all types of information through a Google search, but where do clinicians turn for guidance about complementary, integrative, and alternative medicines?
Some professional societies have published guidelines for the use of unconventional techniques in practice, but Dr. Adler pointed out that they are not appropriate for all patients. The Society of Integrative Oncology (SIO) has developed recommendations for incorporating complementary medicine in breast cancer treatment, for example, but solid tumor cancers are not the same as hematologic malignancies, for which the group has not yet published any guidelines.
The NCCIH collects clinical practice guidelines created by other organizations on its website, which includes two oncology-related resources — the SIO document and guidelines regarding exercise for cancer survivors — but provides little else for patients. Several guidelines address pain and suggest the use of mind-body techniques, but they are not specific to pain associated with hematologic or solid tumor malignancies.
While guidelines about which complementary therapies are most effective may be incomplete, most groups, including the NIH and SIO, are encouraging physicians to ask patients what treatments they are using on their own. “We’re trying to educate the physicians to ask and the patients to tell,” said Dr. Rosenthal.