Putting CAM into Focus
Use of CAM in Cancer Treatment
“WHO Traditional Medicine
Strategy: 2002-2005”
4 major objectives:
Framing policy
Ensuring safety, efficacy and quality
Enhancing access
Promoting proper use of TM/CAM
Conventional Medicine
Broad category of medical practice, sometimes called
Western medicine, biomedicine, allopathic medicine,
scientific medicine, or modern medicine. The efficacy and
safety of the therapies under conventional medicine has
passed and has been actively under continuing
surveillance by both medical and regulatory agencies,
using the so-called evidence based medicine or scientific
clinical trial evaluation.
Conventional cancer medicine – surgery, radiotherapy/ nuclear
medicine therapies, chemotherapy (including hormonal, cytotoxic,
immunologic/biological, gene)
Conventional supportive care interventions - preventive care,
pain control, nutrition, infection control, rehabilitation, psychosocial supportive care, hospice care
Traditional Medicine (TM)
Includes diverse health practices, approaches, knowledge
and beliefs incorporating plant-, animal- and/or mineralbased medicines, spiritual therapies, manual techniques
and exercises applied singularly or in combination to
maintain well-being, as well as to treat, diagnose or
prevent illness.
Plant-based medicines (e.g., Herbal medicine) and Mineralbased medicines (e.g., zinc) - biologically-based therapies
Manual therapies and exercises - manipulative and body-based
methods
Spiritual therapies – mind-body interventions
Animal-based medicines – animals are very important part of
many people’s lives and are a source of companionship and social
support
Complementary &
Alternative Medicine (CAM)
Broad set of health care practices that are not part of
a country’s own tradition and not integrated into
the dominant health care system. Other terms
sometimes used to describe these health care
practices include ‘natural medicine’, ‘nonconventional medicine’ and ‘holistic medicine’.
5 Major CAM Therapies
1.
Biologically-based therapies – use of substances such
as herbs, food, and vitamins to enhance healing and
prevent illness – nutritional supplements, dietary
intervention or restrictions
Herbal Medicine – herbs, herbal materials, herbal
preparations, finished herbal products;
herbs - crude plant material such as leaves, flowers, fruit, seed,
stems, wood, bark, roots, rhizomes etc;
herbal medicine - herbs, fresh juices, gums, fixed oils, essential oils,
resins and dry powders of herbs, and can be processed;
herbal preparations - finished herbal products, made from one or
more herbs
5 Major CAM Therapies
2.
Mind-body interventions – techniques that are
used to enhance the mind’s capacity to affect
bodily function and symptoms –
aromatherapy
cognitive-behavioral therapy
music therapy
dance or movement therapy
art therapy
5 Major CAM Therapies
3.
Manipulative and body-based methods –
therapies based on manipulation and/or
movement of one/more parts of the body –
massage
exercise
rehabilitation and restorative therapy
chiropractic
5 Major CAM Therapies
4.
Energy therapies – includes
biofeld therapies (therapeutic touch, Reiki, Gi gong)
that affect the energy fields that surround and penetrate
the human body,
bioelectromagnetic-based therapies (magnetic fields/
magnet therapy)
5. Alternative medical systems – systems that are
built on complete systems of theory and practice
that evolved apart from conventional medicine –
homeopathic medicine
naturopathic medicine
acupuncture
WHO 3 types of Health System
Structures in relation to TM/CAM
1.
Integrative (e.g., China, Vietnam, Republic of Korea) –
officially recognize and incorporate TM/CAM into all areas of health
care providers.
There are a series of regulations and registration to control the safety,
efficacy and quality of CAM remedies.
The TM/CM practitioners must receive a university education, which
includes knowledge of both TM/CAM and modern medicine, and they
must be licensed to practice.
Patients/ consumers are free to consult both TM/CAM providers and
medical doctors.
The health insurance system covers both forms of treatment, and there
are no communication barriers between TM/CAM practitioners and
medical doctors.
The government regulates actively the use and practice of TM/CAM and
provides consumer education
WHO 3 types of Health System
Structures in relation to TM/CAM
2. Inclusive (e.g., countries including Australia,
Canada, Germany, India, Indonesia, Malaysia,
Singapore, Switzerland, Thailand, USA, Ghana,
Madagascar, Mali, Ukraine, United Arab
Emirates) –
Recognizes TM/CAM, but has not yet incorporated it
into all aspects of health care (e.g., in health care
delivery, education and training, regulation or
research)
WHO 3 types of Health System
Structures in relation to TM/CAM
3. Tolerant (most countries) – health
care is based entirely on conventional
medicine and TM/CAM practices are
not officially recognized as
therapeutics methods or as health
enhancement practices within the
national health care system.
3 Utilization Patterns of TM/CAM
1.
2.
3.
Primary source utilization - TM/CAM is used as primary
source of health care (e.g., many African countries and
some Asian countries – areas where availability and
accessibility of conventional medicine is limited). Mainly
found in a tolerant or an inclusive health care structure.
Dual utilization - Use and prescription of TM/CAM in
conjunction with conventional medicine (e.g., China,
Vietnam, Republic of Korea, many countries in Asia and
South America). Mainly found in integrative or inclusive
systems.
Selective utilization – Use of TM/CAM in a
complementary or alternative role with conventional
medicine (e.g., North America and many European
countries)
Philippines – Cancer Management
Either an inclusive or tolerant health
structure
Utilization of TM/CAM is selective,
depending on the type of remedy and
disease
Complementary Medicine Use
Among Filipino Cancer Patients
(UP-PGH Medical Oncology Study Group, 2005)
Hypothesis: Use of CM is common among UPPGH cancer patients
Prospective cross-sectional descriptive CM
KAP study; pre-tested questionnaire
100 adult (50% IV, 29% III, 9% I-II; 47 yrs
mean age; 88% ECOG <2; 14% no anti-ca tx)
36% consulted a CAM provider
Awareness of CAM Modalities:
Filipino Cancer Patients
CAM Modalities
%
Prayer by self, prayer by others, vitamins, exercise
74-100%
Herbal, vegetarian diet, cleansing/ detoxifying diet
50-64%
Toning or pyramid power, iridology, vacuum cupping,
reflexology, therapeutic massage, acupuncture
38- 48%
Vegan/ macrobiotic diet, psychotherapy, tai chi, hypnosis,
pranic healing, shark cartilage, acupressure, music therapy
15-30%
Chiropractic/ osteopathic, jounaling, melatonin, immune
therapy, bioelectromagnetic, chelation
<10%
*>90% interested to learn more about all forms of CAM
*Info source: #1 Peers; #2 Mass Media
Use of CAM Modalities:
Filipino Cancer Patients
Rank
CAM Modality
% Use
1
Vitamin
51
2
Herbal
41
3
Exercise
24
4
Cleansing/ detoxifying diet
15
5
Vegetarian diet
13
6
Support group
11
7
Gerson’s diet
9
8
Music therapy
7
9
Reflexology, Toning/ pyramid powder, Macrobiotic diet
6
•With prayer/ psychosocial support, 99% use CAM; w/out 81% use CAM; use
2-3 types; Demographic/ clinical profile – no association w/ CAM use
Reason for CAM Use:
Filipino Cancer Patients
Rank Mean
Reason for CAM Use
3.37
To stabilize present condtion
4.00
To boost immune system
4.14
To aid conventional treatment
4.18
To treat cancer
4.31
To improve quality of life
4.64
To have a control over life
5.19
To treat side effects of conventional medicine
6.29
To compensate for failed conventional medicine
Barrier to CAM Use:
Filipino Cancer Patients
Rank Mean
Reason for Barrier to CAM Use
1.87
Lack of information about the therapy
2.52
High cost of treatment
3.09
Lack of time to devote to therapy
3.24
Apprehension over doctor’s reaction to use
4.28
Fear that therapy might be harmful
Reasons for Non-disclosure
of CAM Use to Doctor:
Filipino Cancer Patients
Reason
%
The doctor did not ask
74
Patient is not sure if CAM will help at all
20
The doctor may prohibit use or may disagree with patient
9
The doctor may not understand patient’s use
8
The doctor may stop treating patient
4
•38% reported CAM use to their doctors – 20% were advised
continued use, 25% were advised possible CAM AE
Perception of Conventional Medicine vs CAM Use:
Filipino Cancer Patients
Perception
Weighted means
conv
CAM
pvalue
Prevents spread of cancer
4.52
2.98
0.00
Cures cancer
4.48
3.13
0.00
Relieves symptoms
4.32
3.14
0.00
Assists body’s natural forces to heal
4.22
3.64
0.00
Easy to understand how they work
4.10
3.41
0.28
Prevents recurrence of cancer
4.09
3.25
0.00
Gives feeling of self control over cancer
3.72
3.42
0.00
Safe
3.70
3.69
0.95
Improves quality of life
3.70
3.56
0.28
Weakens body’s natural reserves
3.64
2.87
0.03
Has side effects
3.57
2.89
0.00
Boosts immune system
3.34
3.52
0.00
Reduces chance that the other therapy will work
3.08
2.87
0.13
Disagree = 1-2; Not sure = 3; Agree = 4-5