Alternative and complementary cancer treatments — are they akin to snake oil and mirrors, or are they a poorly-utilized resource in the fight against cancer? “Alternative medicine, in general, is a controversial and under-researched topic,” said Jeffrey White, MD, director, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute (NCI). He explained the term is a generic one, most often used to encompass treatment approaches for which there is generally little or no objective, clinically meaningful research.
However clinicians who use the treatments see their value in results, if not in literature.
Joyce ZaffarUllah, MS, RN, L.Ac, HN-BC, is a staff nurse at New York Presbyterian Hospital, a faculty advisor for The BirchTree Center for Healthcare Transformation and a licensed acupuncturist in private practice in New York City and Malverne, N.Y.
“As a holistic RN, I have given reiki treatments and utilized aromatherapy with patients receiving chemotherapy, as well as before and after surgery,” she explained. “I have also provided acupuncture to patients undergoing chemo and or radiation therapy who confirm how much it helps them in regards to side effects, joint pain, insomnia, hot flashes, anxiety and swelling.
“I feel most, if not all, complementary therapies are beneficial to patient outcomes as overall well-being is increased,” ZaffarUllah told ADVANCE. “When you can help patients reduce pain, reduce anxiety, reduce constipation, improve digestion and get a good night’s sleep, you have contributed to their healing, as well as helping them to continue and complete their treatment.”
In the U.S. complementary and alternative medicine (CAM) therapies are certainly more widely accepted in such supportive roles, used to treat symptoms of cancer, side-effects of cancer therapy or to improve a patient’s quality of life.
“Complementary therapies [e.g. acupuncture, massage, music therapy, dietary supplements], those used along with conventional therapies, for fatigue, nausea, pain and other problems experienced by cancer patients, are more commonly recommended by physicians or allied health professionals than ‘alternative’ therapies,” White advised.
In fact, a lot of private insurance companies do reimburse for acupuncture now, noted ZaffarUllah. “A few hospitals are utilizing reiki, music and aromatherapy. I must commend the Cleveland Clinic for having a Center for Integrative & Lifestyle Medicine and for being among the first in the U.S. to open a hospital-based Chinese herbal therapy clinic,” she added.
Emergence Among Challenges
Although there is interest in developing various alternative therapies, most alternative therapies for cancer do not have sufficient clinical trial results for physicians to consider them appropriate and useful, said White. “These treatments are not FDA approved and generally they are not reimbursed by insurance.”
Case in point: “Mistletoe extract is an example of a cancer therapy which in the U.S. is considered ‘alternative.’ However, in some European countries, these extracts are frequently administered by physicians as an adjunctive cancer therapy and occasionally as a stand-alone therapy,” said White. “Several clinical trials have been performed on mistletoe extracts used alone or with conventional anticancer therapies often with positive results. However, weaknesses in the design of many of these studies often cause physicians to question the value of these findings for making patient care recommendations.” Administered as subcutaneous injections, mistletoe extract is thought to stimulate an anticancer immune response.
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NCI supports a process for reviewing and summarizing the literature about CAM therapies used by cancer patients, including the aforementioned mistletoe extract, in an attempt to build a solid resource base. White pointed to another therapy gaining attention. “Intravenous vitamin C has recently garnered some interest among cancer researchers,” he said. “Most clinical trials of intravenous vitamin C have combined it with chemotherapy. Vitamin C’s anticancer activity is thought to be due to its ability to produce compounds known as free radicals, which cause oxidative damage to various parts of the cancer cell including cell membranes.”
The Issue of Reimbursement
In terms of CAM implementation, the biggest hurdles to deployment “. come down to budget, education and resources,” ZaffarUllah told ADVANCE.
“A lot of alternative and complementary therapies are not reimbursable by insurance plans, so cost is an issue,” she explained. Additionally, she noted most heads of departments, working to achieve increases in HCAHPS scores and reduce costs, do not fully understand how complementary therapies can enhance patient experience and contribute to overall well-being.
“The therapies not only take time, but also require nurses who are qualified to provide the alternative therapies as well as handle the increased patient load and documentation,” explained ZaffarUllah. “Setting up policies and procedures is another function that takes time and resources that are already in short supply.”
But she also was adamant that these hurdles should be addressed – and conquered — because optimum patient care hangs in the balance.
Valerie Neff Newitt is on staff at ADVANCE. Contact: email@example.com.