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WOMEN are generally known to be big users of complementary and alternative medicine, but to what extent do men with cancer use these therapies?
In Australia, one study found that up to 65% of cancer patients use CAM, but the majority of patients studied had breast cancer. When men with prostate cancer from Europe and the USA have been surveyed, CAM use is much lower, peaking at 40%.
A recent study in which I was involved threw some more light on CAM use in male cancer patients.
We surveyed 403 men receiving chemotherapy and/or radiotherapy for a variety of cancers in two public and two private outpatient clinics in SA.
The most common cancers in these men were haematological, prostate, bowel and lung. Just over 81% of them had heard of using CAM to complement their cancer treatment, 62% had used CAM, and 53% were currently using it — higher levels of use than their international counterparts.
Predictors of CAM use included having metastatic rather than local disease, tertiary education compared to primary school level, and active practise of religion. The latter was probably the case because prayer was included as a complementary therapy.
Higher socioeconomic status has been found to be a factor in CAM usage, but in this study it correlated with a higher educational level.
Despite CAM being a widely used term, it really encompasses two different uses for these therapies. Most commonly they are used to complement standard treatment rather than being adopted as an alternative to conventional therapies.
The most popular therapies in our study were dietary supplements with herbs and plants, relaxation and meditation, and prayer. One theory on the reason why patients use CAM is that they are either dissatisfied with their conventional medical treatment or attracted to the rationale for a particular alternative therapy.
Most worrying in our study is that only 9.9% of patients were actually referred by their specialist to use CAM. The main non-medical sources of information about CAM come from family then friends, the media, including the internet, and other patients.
Conventional specialists should be aware that more than half their patients use CAM. Doctors need to create an environment where patients can talk about their use of CAM without the fear of disapproval, if for no other reason than complementary therapies may have serious drug interactions with conventional therapies.
The doctor does not have to condone the use of CAM — and there are other positive outcomes from such discussions.
Patients may reveal dissatisfaction with their conventional treatment or gaps in their understanding of their disease. Men may reveal opportunities to better support their social and emotional concerns.
Opportunities can arise to talk about both the risks and benefits of treatments and what evidence is used to select a treatment. This can highlight the difference between scientific evidence for conventional treatments and testimonials and anecdotes to support the use of alternative therapy.
Doctors may be able to support practices which are complementary to conventional medicine if they will not cause harm and where the patient reports symptomatic benefit. However, the use of an unproven treatment as an alternative to conventional medicine is risky and should be discouraged.
Patients may seek guidance about alternative therapies and medical practitioners are best placed to provide this. Therefore, doctors need to be educated about CAM and become familiar with websites which carry information about the wide range of therapies on offer. Cancer Council Australia is a good starting point.
More research is needed into the mechanism of CAM, and trials of popular therapies should be performed to evaluate efficacy so beneficial treatments may more readily be integrated into holistic care.
Professor Ian Olver AM is the chief executive officer of Cancer Council Australia, adjunct professor in the school of medicine, University of Adelaide, and clinical professor in the department of medicine, University of Sydney.
Posted 5 December 2011
As a user of some CAMs, in addition to medications prescribed which I cannot not take since some of them actually keep me alive, I comment on a possible reason why higher economic status often means greater use.
My prescribed medications come to me with help from the government, thank goodness. But the CAMs I use, because those prescribed haven’t helped – and have in some cases done harm – are so very expensive that I am forced to think very carefully before using them. I only use those I must, simply because of the cost. If I had more money I would not find myself in a position where I sometimes have to decide between taking what I need and buying food or clothing. Not a good place to be, and surely isn’t helping my health to have this stress.
so is it unethical for me to crush up some leaves from a random plant, call myself a doctor, advertise that I can treat cancer, claim no side effects, tell my patients that western medicine is a conspiracy to keep you sick so that it can make money from big pharmaceutical companies, claim that science doesn’t understand the holisitic natural approach, make money selling this stuff, claim any placebo benefit as real, and blame the patient’s other medications if any side effects occur? It seems this is what many of you are defending.
Chris – you had the perfect twin study. You could have treated one twin, let the naturopath treat the other, and see who did better!
I never thought of the chaplains wandering around the hospital as “alternative practitioners”. Many of my patients use CAM, a give-away is the patient asking for a copy of their path results – to check with the naturopath that our treatment is OK. My line is to say that if the CAM practitioner doesn’t interfere with my treatment, I won’t interfere with theirs. Had identical twins with Graves disease. Treated with NeoMercazole by me and massage of their big toes by the naturopath (Graves is a pituitary disease which has links to the big toes- doncha know). They got better but I bet mum attributed their recovery to her massage.
Bruni brewin asks “If the patient reports symptomatic benefit – what is the reason we should discourage what causes the benefit just because it is as yet an unproven treatment…?” Well, for examples like prayer, meditation and yoga or exercise, probably none at all. But, for fraudulent, unproven or just illogical placebo remedies that are sold by “practitioners” as effective treatments, the problems are both financial cost and dishonesty.
It’s just a matter of: does one treatment regimen fit all? and just too bad if it doesn’t!
If the patient reports symptomatic benefit – what is the reason we should discourage what causes the benefit just because it is as yet an unproven treatment, or even if it benefits no one other than the patient? We have enough knowledge about the placebo effect to know how powerful it can be. I am not suggesting that it should be encouraged. But if the patient is telling you that (s)he is gaining this benefit, providing it is not working against the traditional medicine the patient is already under, then surely the patient is giving you the message that this is helping her/him. There is also such a thing as the nosebo effect where the patient is told of the possible negative effects of a medication such as nausea, only to be given a control placebo pill, yet the patient experiences the nausea because they believe that they have actually taken the real pill. Research tells us what most of the people feel most of the time – if a patient is not ‘most of the people’ and we deal holistically with patients, then a patient centered approach would lead to the best results for that patient.
There seems to be a fundamental ignorance in professional circles of ‘human makeup’ – whether individuals like.it.or.not,
know.it.or.not or just plain “think they do”…..
Man IS “tripartite”, ie; he is 1) physical body 2) soul = mind, will & emotions 3) spirit……….SO unless each aspect is considered and cared for it all dimensions, particularly in relation to healing of sickness and disease progress will be incomplete………hence the term, HOLISTIC…(whole)
Rob, I have thought similarly to you for a long time but this post changed my mind. What Prof Olver is saying is that discussions about other treatment modalities patients might be using open an important door in doctor-patient communication. Sure, the use of prayer or meditation is not dangerous per se, but knowing that patients hold a belief about such things is important for approaching their care holistically and making a management plan that will work for them. I agree that herbal and nutritional supplements pose a different dilemma. It is vital to discuss any use of these with patients, but how much better to open up the discussion to include other modalities and beliefs.
It is quite misleading to include prayer, relaxation and meditation under the heading of ‘CAM’. These are harmless activities which are a normal part of life for many healthy people, and are only of concern when patients use them as an alternative to orthodox medical treatment. By contrast, herbal and other nutritional supplements have the potential to interact adversely with drug treatment and their use is of potential concern. Please can we have some more meaningful statistics?