The Use of Complementary, Alternative, and Integrative Therapies in Cancer Care

Complementary and alternative therapies are described best as those not presently considered an integral part of conventional medicine. Complementary therapies are used in conjunction with conventional medicine, alternative therapies are used in place of conventional medicine, and integrative therapies combine mainstream medical therapies with complementary or alternative therapies for which some high-quality scientific evidence of safety and efficacy exists (National Center for Complementary and Alternative Medicine [NCCAM], 2004). Approximately 72 million adults in the United States use complementary and alternative therapies (Tindle, Davis, Phillips, & Eisenberg, 2005), and more than $34 billion per year is spent out-of-pocket for these therapies (Herman, Craig, & Caspi, 2005). Many researchers are examining the efficacy and safety of complementary and alternative therapies. The National Institutes of Health established NCCAM to fund research in complementary and alternative medicine (CAM) and created the Office of Cancer Complementary and Alternative Therapies to coordinate and enhance the National Cancer Institute's CAM activities. Complementary and alternative practices have been categorized broadly as mind-body interventions, manipulative and body-based methods, biologically based methods, energy therapies, and alternative medical systems (NCCAM, 2004). However, the list of complementary and alternative practices will continue to evolve as new therapies are proven to be safe and effective, accepted as mainstream healthcare practices, and integrated into patient care. The most frequently used CAM therapies include prayer, natural products, deep breathing, meditation, chiropractic, yoga, and massage (Barnes, Powell-Griner, McFann, & Nahin, 2004). Researchers have reported that 50%-83% of patients with cancer use CAM therapies (Basch & Ulbricht, 2004), and the most common reason for using CAM is a strong belief in its efficacy (Verhoef, Balneaves, Boon, & Vroegindewey, 2005). However, 40%-77% of people who use CAM therapies do not disclose CAM use because of concerns that healthcare providers will react negatively, because of a belief that healthcare providers do not need to know that they are using CAM because they regard it as natural and safe to use, and finally, because healthcare providers do not ask about CAM use (Robinson & McGrail, 2004). Oncology nurses may be caring for patients without knowledge of concurrent CAM use. Routine assessment of CAM use and close monitoring of patients using CAM therapies have the potential to enhance patient safety and promote integrative care (Lee, 2004).

It Is the Position of ONS That

• Oncology nurses should expand their individual knowledge regarding complementary, alternative, and integrative therapies in oncology care.
• Formal cancer care education programs in schools of nursing and continuing education offerings should include information and access to complementary, alternative, and integrative therapies and promote integrated education with other health disciplines.
• Oncology nurses should seek proper training and obtain necessary credentials if practicing complementary, alternative, and integrative therapies.
• Oncology nurses should develop a working knowledge of cost, reimbursement, liability, ethical, and legal issues surrounding complementary, alternative, and integrative therapies in oncology care.
• Oncology nurses should evaluate their personal and professional beliefs regarding the use of complementary, alternative, and integrative practices and recognize how these values can affect the care of patients seeking or using these therapies.
• Oncology nurses should assess patients for the use of therapies and provide evidence-based information and resources regarding therapies as well as information about verifying practitioners' qualifications and credentials.
• Oncology nurses should have an awareness of the differences among terms applied to CAM and use the terms alternative, complementary, and integrative with consistency and in an appropriate context.
• Oncology nurses should develop an awareness of CAM therapies that potentially can interfere with the outcome of other cancer treatments.
• Oncology nurses should document patients' use of and response to CAM therapies.
• Oncology nurses should establish evidence-based practice in these areas by synthesizing present knowledge with regard to safety, efficacy, concurrent use with conventional therapy, and long-term use.
• ONS and its affiliates promote funding and collaboration in the design of methodologically rigorous cancer CAM treatment and supportive care clinical trials to study the impact of complementary, alternative, and integrative therapies on cancer care outcomes.

References

Barnes, P.M., Powell-Griner, E., McFann, K., & Nahin, R.L. (2004). Complementary and alternative medicine use among adults: United States, 2002. Advance Data, 27, 1-19.

Basch, E., & Ulbricht, C. (2004). Prevalence of CAM use among U.S. cancer patients: An update [Editorial]. Journal of Cancer Integrative Medicine, 2(1), 13-14.

Herman, P.M., Craig, B.M., & Caspi, O. (2005). Is complementary and alternative (CAM) cost-effective? A systematic review. BMC Complementary and Alternative Medicine, 2, 11.

Lee, C.O. (2004). Clinical trials in cancer part II. Biomedical, complementary, and alternative medicine: Significant issues. Clinical Journal of Oncology Nursing, 8, 670-674.

National Center for Complementary and Alternative Medicine. (2004). The use of complementary and alternative medicine in the United States. Retrieved November 16, 2004, from http://nccam.nih.gov/news/camsurvey_fs1.htm

Robinson, A., & McGrail, M.R. (2004). Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies. Complementary Therapies in Medicine, 12, 90-98.

Tindle, H.A., Davis, R.B., Phillips, R.S., & Eisenberg, D.M. (2005). Trends in use of complementary and alternative medicine by U.S. adults: 1997-2002. Alternative Therapies in Health and Medicine, 11, 42-49.

Verhoef, M.J., Balneaves, L.G., Boon, H.S., & Vroegindewey, A. (2005). Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: A systematic review. Integrative Cancer Therapies, 4, 274-286.

Approved by the ONS Board of Directors 04/00; revised 06/02, 10/04, 03/06.