Editorial: What is the Role of Complementary Medicine in Modern Cancer Care?

Issue: Vol.7, No.3 - July 2008

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Article Type: Editorial

Dr David Joske,
Head of Haematology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands WA 6009
Founder and Chairman, SolarisCare Foundation

This work is an abbreviated version of an address to The Australian Integrative Medicine Association Conference, Leura NSW, August 2007. It was published in full in the conference proceedings.

Australians live in a cancer-phobic society, perhaps best exemplified by the well-intentioned slogan "Cancer is a word, not a sentence". The media tend to portray cancer in simplistic and subjective terms that do a great disservice to Australians with cancer. A survey of eighteen newspapers, examining 5,474 articles about cancer in the United Kingdom in 1999 found that all cancers were portrayed as one disease; articles focused on the shock of diagnosis, the horrible treatment, implied the outcome was known after three months and tended to portray individuals with cancer as 'warriors' (especially if famous!) or 'victims' (Jane Maher, Personal Communication). When The Honourable Jim Bacon, then Premier of Tasmania, publicly announced in February 2004 that he had lung cancer, he was inundated with well-wishing communications sent by post, e-mail and other means. They included, 157 items of correspondence recommending a wide variety of complementary and alternative medicines (CAMs; Lowenthal, 2005). Cancer is much feared and widely discussed.

The cancer reality is indeed sobering. In 2001 there were 88,398 new cancer cases in Australia and 36,319 deaths due to cancer, representing 257,458 potential years of life lost to the community. One in three men and one in four women will be diagnosed with some form of cancer. In 2001, A$2.7 billion were spent on cancer, including $250 million on cancer research (Cancer in Australia 2001).

Is it possible, with access to the latest developments in cancer medicine (including some stunning breakthroughs in leukaemia), that mainstream medicine in Australia has come to focus too much on the curing and not enough on the healing? Curing represents eradication of disease, where healing represents achieving the best possible physical and psychological health in an individual, even if disease such as cancer can not be eradicated. In focusing on curing, unnecessary distress and grief may be engendered for the patient, their carers and relatives. We must 're-humanise' health care. Just because we have grown up with a high-technology, high-pressure, short-appointment, harried-health-professional face of modern health care,it doesn't mean we should accept this is the best way to go.

And we aren't. This is at least in part why Australians, with cancer, like their brothers and sisters world-wide, are turning to CAM:-- for a more humanistic approach. Between 40 and 70% of people with cancer use CAM in some form(Ernst & Cassileth 1998; Molassiotis etal 2005); the figure rises to 90% in the US if prayer is included! (Yates et al 2005). And although this represents an attempt to wrest control of a terrible situation - our business leaders would commend such a pro-active step - patients were and are often humiliated for doing this. Cancer patients will continue to turn to complementary and/or alternative medicine (CAM). These are vulnerable patients and the mainstream medical community is rightly skeptical of snake-healer treatments and quacks who promise a lot, often at great expense, and stand in the way of patients accessing effective treatment. Nevertheless, mainstream medicine, with its bio-technological and reductionist approach,studying diseases and populations, often fails to provide a humane situation where an individual can respond to their illness in a positive and self-empowering way. Turning to complementary medicine is one way that people with cancer can start to take control of the situation and do something themselves, as opposed to being told what to do and what to take and how to feel. People with chronic illness, including cancers, should be encouraged to do this and thus the mainstream community must now have some understanding of CAM. We need to know which CAM modalities are appropriate, and for which there is evidence of efficacy in controlling symptoms, versus those that are harmful.

Six years ago, I decided to buy into the CAM controversy and make selected therapies available in a cancer support centre in my teaching hospital; the alternative was to feel there would always be a barrier between my patient and me; this was not acceptable. My response as a physician and a person to a gnawing and growing feeling that more support was needed for my patients was to set up the SolarisCare Foundation Cancer Support Centre in a mainstream teaching hospital (formerly the Brownes Cancer Support Centre). It provides safe and supervised access to complementary therapies, cancer advice and information, within, if slightly apart from, the teaching hospital setting. Since its inception, the Centre has had between 100-200 visitors a week, of whom about half are cancer patients and their carers and who access complementary therapies.There are minimal paid staff and at present around fifty volunteer 'meet-and-greet' staff and 50 complementary therapists. The decision was made, based on a review of the literature (Joske et al 2006), to concentrate upon massage-based or psychological interventions. Medico-legal risk was minimised with careful selection of do's and don'ts for the therapists, with third party insurance supplied by the hospital itself, and with careful selection and four weeks observation of therapists prior to commencing treatments in the Centre. A second centre opened in July 2008, at a private hospital with a large cancer centre, and a 'Chemo Club' has been available since November 2006 at a local gymnasium offering supervised resistance training for chemotherapy patients. All treatments and the Chemo Club are free. Uncontrolled and blunt quality of life and symptom distress data was collected over five years using a modified instrument adapted from the palliative care setting.

Very briefly, data has been collected in over 1000 cancer patients(Joske et al 2005). 80% of them are women: 55% of those with cancer have breast cancer; 20% of the visitors are carers of patients with cancer. The data shows small, but measurable, improvements in quality of life, and reduced cancer symptoms,over the course of six free CAM sessions. The main symptoms that have shown a response to this approach are pain and fatigue, two of the most troublesome problems in cancer patients. More research is needed before we can definitively state that this is due to the Centre itself. However, anecdotal reports from patients suggest improved compliance with mainstream treatment ("I used to dread coming to the hospital for chemo, until I started using the Centre for a massage session afterwards"). Amongst my own patients, I sometimes see a turnaround in psychological demeanor, after a visit to the Centre, to a more pro-active and on-side approach with the mainstream treatment. We also find that the Centre and the Chemo Club provide a sense of community for socially isolated cancer patients (sometimes from the very wealthiest suburbs!), and a tangible focus point for the wellspring of support from the community at large who want to help. Evidence that complementary therapies alter cancer survival at this stage is lacking, and that is not really the point.

Thus, the availability of safe, supervised complementary therapies may have much to offer an over-stressed health system and Australians battling through the cancer journey: non-pharmacological ways to help control cancer symptoms and treatment side effects such as pain, fatigue and nausea; a chance for cancer patients to be pro-active and empowered; and a way to harness a large groundswell of community goodwill to help.

Modern medicine will deliver more improvements and breakthroughs. Many exciting new areas of research have been opened in population genomics, proteomics and micro-array, to name just a few. Whilst these are eagerly awaited, the challenge for all of us providing mainstream health care is to maintain a humanistic people-centred approach. Some very ancient forms of healing, discredited for centuries, may offer one way to re-humanise health care, empower patients and ensure a human face remains on our health care system. Hippocrates knew the difference between curing and healing;he said: "Cure occasionally, relieve often, comfort always".

Lowenthal, R. Public illness: how the community recommended complementary and alternative medicine for a prominent politician with cancer. Med J Aust 2005; 183:576-579.
Cancer in Australia 2001. Australian Cancer Institute of Health and Welfare and Australasian Association of Cancer Registries 2004. AIHW Cat. No. 213 Canberra.
Ernst E, Cassileth BR. The Prevalence of Complementary/Alternative Medicine in Cancer. Cancer. 1998; 83: 777-782
Molassiotis A, Fernandez-Ortega P, Pud D et al. Ann Oncol.2005 Apr;16(4):655-63. Epub 2005 Feb 2.
Yates JS, Mustian KM, Morrow GR, et al. Prevalence of complementary and alternative medicine use in cancer patients during treatment. Support care Cancer 2005 Oct; 13(10):806-11. Epub 2005 Feb 15.
Joske DJL, Rao A, Kristjanson L. Critical review of Complementary therapies in haemato-oncology. Int Med J 200636 479-586.
Joske DJL, Popescu A, Kristjanson LJ, Wallis K, Oliver D. Complementary medicine therapies in a teaching hospital. In Cohen M. (Editor) The Art and Science of Holistic Health AIMA, Clayton, 2005:146-153.

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