Complementary therapies and cancer care

During the last

decade we have

seen the two

opposing

extremes come

together to share

a middle

ground...

The psycho-

logical therapies

also have

extreme variants

which may pose

considerable

dangers to

some patients,

especially if carried out by

inexperienced

practitioners.

Lucy Bell Complementary Therapy Co-ordinator

Karol $ikora Professor of Clinical Onr Directorate of Cancer Services, Hammersmith Hospitals Trust, London W 12 ONN, UK

(Requests for offprints to LB)

Complementary therapies have been widely used by cancer patients for many years. The failure of mod- em medical science to live up to its expectation to cure the majority of common cancers, together with an increasing self empowerment of those with life threatening illness, have resulted in a dramatic increase in interest in both complementary and alter- native treatments for cancer.

There is a wide spectrum of belief in complemen- tary medicine. In the past it has been seen by some as a true alternative to orthodox medicine. Surgery, radiotherapy and chemotherapy were regarded as evil - cutting, burning and poisoning. Zealots hold- ing this view did untold damage in dissuading peo- ple from having potentially helpful treatment. Often these views emanated from charismatic practitioners who were far from holistic - indeed they usually pursued single treatment modalities such as electri- cal and crystal therapies, extreme diets with detoxi- fication or semi-secret organic remedies. At the other end of the spectrum, and equally damaging, was the patronizing paternalism of establishment medicine - readily dismissing the potential of com- plementary medicine to help people. During the last decade we have seen the two opposing extremes come together to share a middle ground, whereby pooling knowledge and understanding, patients can gain immensely.

Steering a reasonable middle ground is not easy. In 1989, at the Hammersmith Hospital, we began to introduce complementary therapies such as massage and relaxation to our routine radiotherapy and chemotherapy services. We enlisted the experience of the Bristol Cancer Help Centre to see how we could best integrate their pioneering work into our very orthodox setting. The physical environment was very unsuitable but we have since built a new cancer centre designed in part for a gentler approach to our patients. We employed a supportive care man- ager and sessional staff covering massage, reflexol- ogy, aromatherapy, counselling, healing, spiritual help as well as incorporating into our programme staff from other hospital sections such as the chap- laincy, dietetics and psychiatry. We have a library of books, tapes and videos together with aromatherapy oils and burners on all wards and departments. We have developed contacts in the community with can- cer support organizations locally and also with local practitioners of complementary therapies. In addi- tion we have a staff support group. By far the most

popular service has been massage and reflexology and a clinical trial is now in progress to assess their

effects. Complementary therapies can be grouped into

three subdivisions which have considerable overlap.

Psychological Physical Pharmacological

Counselling Massage Dietary intervention Psychotherapy Aromatherapy Vitamins Healing Reflexology Sharks cartilage Visualization Shiatsu Naturopathy Yoga Acupressure Chinese medicine Radionics Acupuncture Essiac Psychic surgery Osteopathy Homeopathy Art therapy Chiropractice Laetrile Rebirthing Detoxification Hypnosis Immunostimulation

The pharmacological therapies are especially popular in the USA, where .a_vast information net- work has been established initially through special- ist book publishers and more recently on the inter- net. They are much less popular in Britain, although vitamins and homeopathy are widely utilized. There are considerable difficulties surrounding the use of pharmacologically based therapies in an orthodox clinical setting. It would be illogical not to apply the same scrutiny for, say, sharks cartilage or high dose vitamin therapy as for any anti-cancer agent. And yet the beneficial results often claimed are extreme but with only anecdotal evidence. Some practition- ers of such treatments may well promise cure from the disease, often at considerable expense. The psy- chological therapies also have extreme variants which may pose considerable dangers to some patients, especially if carried out by inexperienced practitioners. These include the more extreme forms of psychic surgery and rebirthing experiences which can lead to long lasting and damaging psychotic

reactions. Many cancer centres in Britain have been devel-

oping programmes following a similar pattern to us and avoiding the pharmacological and more extreme psychological and physical therapies. Well devel- oped schemes are currently in operation at the Mount Vernon and the Royal Marsden Hospitals in London and at many hospitals throughout Britain. But there are several factors that have slowed down

such developments. The first is resources - there is simply no free cash

in today's National Health Service. It would be invidious if we were forced to make a charge for

Complementary Therapies in NursJng and Midwifery (I 996) 2, 57-58 �9 1996 Pearson P r o f ~ Ltd

58 Complementary Therapies in Nursing & Midwifery

Indeed the gold standard of the

randomized clinical trial may

often be an inappropriate

tool for this type of research which

may need new paradigms for its

analysis.

complementary care. Our programme received dona- tions and private practice fees paid to the University department. More recently we have persuaded our purchasers to invest in a complementary medicine programme managed by our nursing staff. We have converted some nurse sessions into providing a part- time complementary therapy resource. At the same time we have encouraged staff to attend seminars, courses and, where appropriate, obtain formal quali- fications in complementary therapy.

However, there still remains pockets of antago- nism amongst senior medical and nursing staff. This often results in a continuous undermining and even covert sabotage of any complementary service being established. The demand from our patients, to whom we are ultimately responsible is unquenchable. Indeed, it can be seen in the High Street in retail pharmacies where complementary medicine sits comfortably besides more orthodox approaches. Public opinion has shifted very much towards a more open approach.

The third problem is the lack of high quality research showing benefit. Most of us believe that complementary therapies are helpful in improving the quality of life of many cancer patients. It may even have a small but measurable effect on disease free and absolute survival of many different cancer types. The problem is proving it through rigorous and preferably randomized clinical trials. This area

of research is extremely challenging. Different lev- els of patient motivation together with the problems in assessing quality of life make things very difficult indeed for the investigator. Indeed the gold standard of the randolnized clinical trial may often be an inappropriate tool for this type of research which may need new paradigms for its analysis. It is easy for those involved in purchasing services to use the lack of good conventional data showing benefit as an excuse to turn down applications for funding.

There are many models for the use of comple- mentary therapies and some are illustrated in this issue. Some are integrated with conventional thera- pies either active in a cancer treatment centre or pal- liative within a hospice. Other approaches such as the Bristol Centre or the Royal London Homeopathic Hospital are free standing, relatively intensive introductory courses, at which the patient is given a taste of different approaches. Longer-term arrangements can then be made close to the patient's home to pursue particular therapies should they wish. There are advantages and disadvantages of each of these schemes but both have a vital role in providing for the optimal care for the cancer patients as a whole.

Lucy Bell Complementary Therapy Co-ordinator

Karol Sikora Professor of Clinical Oncology