A departure from convention is worth a look

What do we really know about the efficacy of various complementary therapies to treat symptoms or improve health?

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What are complementary therapies? Basically, CTs are any product or therapy used to improve health or treat symptoms outside of conventional medicine. Specific therapies that are considered complementary versus conventional are constantly changing, as evidence mounts to support their efficacy. For example, 25 years ago support groups for cancer patients were thought to be a terrible idea – a bunch of sick people getting together to talk about it would surely do more harm than good!

Now, nearly every cancer centre offers such support groups because there has been so much research and evaluation supporting their helpfulness, and they are just part of conventional care.

We often divide CTs into five categories:

  1. Natural health products: These are things you ingest, including herbs, minerals, vitamins and other botanicals.
  2. Mind-body therapies: These are mental techniques used to improve health, including approaches like meditation, imagery, hypnosis and relaxation.
  3. Manipulative therapies: These are things you do to the body, like massage, chiropractic procedures or osteopathy.
  4. Energy therapies: These approaches all work on the premise of balancing energy fields in the body, such as Reiki, acupuncture and Tai Chi.
  5. Whole-systems approaches (such as Traditional Chinese Medicine, Ayurveda or Homeopathy): Each of these approaches has its own philosophy about health and healing and a number of treatments are derived from that.

I did a survey in 2012 with psychology honours student Ngaire King of nearly 500 people with cancer and 100 health care providers at Calgary’s Tom Baker Cancer Centre. We asked about patients’ knowledge, communication and support-making decisions about which CTs to use in cancer care.

While about half of the cancer patients had started taking some form of CTs since their diagnosis – the most popular were natural health products and mind-body therapies – and the other half were considering using CTs, only 20 per cent of the patients said anyone at the cancer centre had asked them about it. Only 15 per cent felt satisfied with the communication and decision support they had received. Participants also reported feeling they lacked the knowledge to make their own decisions about what kinds of CTs to use.

For their part, the health-care providers also felt unknowledgeable about CTs, with most reporting having received only minimal or no education about the efficacy of CTs for cancer patients. They were interested in learning more, but that kind of training is rarely provided in medical or nursing school curricula.

The good news is that we are addressing these omissions through our integrative oncology education programs at the Tom Baker Cancer Centre. Beginning in 2012, I have provided a monthly educational seminar for all patients or support people to attend; it’s usually on the third Wednesday of the month.

We are also in the process of adapting online training materials from the B.C. Cancer Agency (BCCA) for health-care providers and plan to test their efficacy in improving the confidence of professionals, as well as their knowledge about CTs and their ability to counsel patients on which products to use and which to avoid.

Hopefully, if we redo the surveys in a few years, most patients will feel supported and knowledgeable about which CTs may work for them, and health-care providers will also be more comfortable talking to patients about their use and interest in CTs.

Dr. Linda Carlson (lindacarlson.ca) is the Enbridge Chair in Psychosocial Oncology at the University of Calgary and a clinical psychologist at the Tom Baker Cancer Centre.

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