Integrating CAM therapies into oncology care
Patients with cancer often raise questions about how they might use integrative therapies, complementary therapies, and alternative treatments. Oncology nurses should be knowledgeable about these areas so they can discuss them with patients and answer their patients' questions. An estimated 10% to more than 60% of oncology patients use other therapies in addition to their prescribed treatment.1 Skillfully discussing these approaches allows patients to freely discuss all choices in their care.2
DEFINING INTEGRATIVE ONCOLOGY
Nurses should understand the subtle differences in meaning of several terms that are often used loosely.3 Collectively, the whole spectrum of therapies is termed complementary and alternative medicine (CAM). Complementary therapies and medicine are used in conjunction with conventional medical treatments, whereas alternative therapies and medicine are used instead of and by excluding conventional medical care. Cancer treatments that are truly alternative to conventional care can result in patients postponing needed and proper treatment, and, in turn, reduce the likelihood of achieving remission and cure.
In contrast, integrative therapies and medicine are similar to complementary therapies but are more grounded by research evidence and are truly integrated with conventional medicine. These therapies are rational, evidence-based approaches. They help to relieve physical and emotional symptoms, improve quality of life, and they may result in greater adherence to oncology treatment regimens.
FINDING RELIABLE INFORMATION
Integrative oncology approaches are studied by the National Institutes of Health (NIH) at the National Center of Complementary and Alternative Medicine (NCCAM) and at the National Cancer Institute (NCI) Office of Complementary and Alternative Medicine (OCCAM). NCCAM divides complementary and alternative therapies into five categories: natural products, mind-body medicine, manipulative and body-based practices, whole medical systems, and other CAM approaches. Be aware that these categories often overlap, so therapies may fit into more than one category.
Many professional organizations provide further information about integrative oncology. The Society for Integrative Oncology, a nonprofit, multidisciplinary organization, strives “to advance evidence-based, comprehensive, integrative healthcare to improve the lives of people affected by cancer.”4 The organization hosts an annual conference to examine the evidence for complementary therapies, and its Web site includes information, links, and resources for clinicians and patients.
Members of the Oncology Nursing Society (ONS) can join special interest groups to share information and learn from each other's experiences. The organization has a special interest group that focuses on complementary and integrative therapies. This group of 900 members publishes a newsletter, offers networking opportunities, and meets during the ONS Annual Congress.
Books on integrative oncology for health care professionals are available from ONS and commercial booksellers. These include the Handbook of Integrative Oncology Nursing: Evidence-Based Practice, written by Georgia M. Decker and Colleen O. Lee (published by Oncology Nursing Society; Pittsburgh, PA; 2010) Integrative Oncology, by Donald Abrams and Andrew Weil (published by Oxford University Press USA; New York, NY; 2009); and Integrative Oncology: Principles and Practice, by Matthew P. Mumber (published by CRC Press; Boca Raton, Florida; 2005).3
For patients, the American Cancer Society (ACS) offers its Guidelines for Using Complementary and Alternative Methods, available on the ACS Web site. Information on dietary supplements and herbs can be found at Medline Plus: All Herbs and Supplements, from the NIH Office of Dietary Supplements, and through a PubMed information subset on dietary supplements.
CONSIDERATIONS WHEN REVIEWING EVIDENCE
Sources of information on integrative oncology should be unbiased and peer-reviewed. Check that information sources used appropriate research methods, discuss both safety and efficacy, and identify the limitations of the research and any clinical concerns.3 While double-blind, randomized controlled trials are the gold standard, this methodology may not be the best approach for therapies such as whole medical systems and mind-body interventions.5 For example, mindfulness-based interventions involve adopting new health behaviors, which makes them similar to other behavioral approaches. Theories of behavioral change emphasize the importance of a person's intention, willingness, and readiness to change health behaviors, which randomized controlled trials are not likely to address adequately.3 Additionally, qualitative approaches should be considered, which include first-person perspectives and observational methods, since these are helpful in understanding the experiences of patients.