© The Author (2008). Published by Oxford University Press. All rights reserved
How Should Oncologists Face Complementary and Alternative Medicine?
Department of Gastroenterology and Hepatology, University of Tsukuba, Tsukuba, Japan
There are many inconsistent usages of complementary and alternative medicine (CAM) in modern medicine. Once a kind of CAM is evaluated on the basis of scientific method and is revealed to have the substantial effects and acceptable downsides against some malignancies, it would be integrated into standard oncology care as major or supportive medicine.
CAM is outside the evidence-based medicine. In other words, modern medical practitioners named the experience-based or traditional medicine that has not been assessed scientifically yet as CAM, as a tentative and generic term. Humankind have profited greatly from the development of medicine. However, this benefit is mainly limited to those living in the developed countries, and traditional medicine is still a mainstream in many other countries. Many people throughout Africa, Asia and Latin America use traditional medicine to meet their primary health-care needs. It is easily accessible and affordable for them. Traditional medicine is also often part of a wider belief system and is considered integral to everyday life and well-being.
In Western countries, CAM is increasingly being used in parallel to allopathic medicine, particularly for treating and managing chronic disease. Concerns about the adverse drug effects, a desire for more personalized health care, and greater public access to health information fuel the increasing use of CAM in many developed countries. Recent surveys demonstrate that >50% of US cancer patients use CAM therapies at some point after their diagnosis. Despite extensive use, there is a paucity of data available to indicate whether these therapies are efficacious and safe. An enormous amount of unreliable information on cancer CAM is released into the Internet and other media sources. CAM products (herbs and other natural products, such as shark cartilage, mushrooms etc.) in cancer medicine are widely available in Japan and the Western countries (1). Internet and its marketing have accelerated it. The providers emphasize their effects on boosting the immune system based on the pre-clinical experimental findings and advertise using anecdotal reports of users. No reliable and well-designed clinical trials in cancer patients have been performed with this kind of products. Nonetheless, many cancer patients use such products hoping for tumor growth suppression and cure rather than complementary effects. These natural products are generally expensive. It is often the case that the cancer patients and their relatives are at a loss about how to deal with such information and have a difficult time choosing what kind of CAM they should adopt. Oncologist cannot advice them appropriately due to the lack of evidence and even information. A great need for public and professional education regarding this subject is evident.
Munshi et al. (2) have reviewed the prominent modalities in CAM for cancer treatment in this issue of JJCO. They see CAM in oncology practice as a complicated issue like a Pandora box in a medical labyrinth. Many oncologists can share this thought. They tried to search evidence on CAM in the literatures and could not find many well-designed trials. A few kinds of CAMs (yoga, acupuncture, some herbal medicine, homeopathy etc.) have been studied in clinical trials. However, the evidence from randomized controlled trials is fragmentary and inconclusive. Therefore, many kinds of CAMs could not be evaluated properly for both efficacy and safety.
Many previous reports on CAM indicate that more reliable evidence-based information on CAM is needed for better patient–physician communication (3). The lack of useful information on CAM makes oncologists tend to neglect CAM and avoid communication with patients on its usage. To resolve this problem, a study team consisted of oncologists, pharmacists, psychologists, nurses and CAM providers was organized by the research grant from the Ministry of Health, Labor and Welfare. They are now aggressively educating cancer patients on CAM and evaluating natural products used for cancer treatment in the prospective comparative studies. Another remaining issue is the high prevalence of the concurrent use of anticancer drugs and CAM. Our present knowledge of interactions is incomplete, and further study is urgently needed.
References
1 Hyodo I, Amano N, Eguchi K, Narabayashi M, Imanishi J, Hirai M, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol (2005) 23:2645–54.
2 Munshi A, Ni LH, Tiwana MS. Complementary and alternative medicine in present day oncology care: promises and pitfalls. Jpn J Clin Oncol (2008) 38:512–20.
3 Hyodo I, Eguchi K, Nishina T, Endo H, Tanimizu M, Mikami I, et al. Perceptions and attitudes of clinical oncologists on complementary and alternative medicine: a nationwide survey in Japan. Cancer (2003) 97:2861–8.[CrossRef][Medline]
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