Putting CAM into Focus

Use of CAM in Cancer Treatment

“WHO Traditional Medicine

Strategy: 2002-2005”

4 major objectives:

� Framing policy� Framing policy

� Ensuring safety, efficacy and quality

� Enhancing access

� Promoting proper use of TM/CAM

Conventional MedicineBroad category of medical practice, sometimes called

Western medicine, biomedicine, allopathic medicine,scientific medicine, or modern medicine. The efficacy andsafety of the therapies under conventional medicine haspassed and has been actively under continuingsurveillance by both medical and regulatory agencies,using the so-called evidence based medicine or scientificclinical trial evaluation.

� Conventional cancer medicine – surgery, radiotherapy/ nuclearmedicine therapies, chemotherapy (including hormonal, cytotoxic,immunologic/biological, gene)

� Conventional supportive care interventions - preventive care,pain control, nutrition, infection control, rehabilitation, psycho-social supportive care, hospice care

Traditional Medicine (TM)Includes diverse health practices, approaches, knowledge

and beliefs incorporating plant-, animal- and/or mineral-based medicines, spiritual therapies, manual techniquesand exercises applied singularly or in combination tomaintain well-being, as well as to treat, diagnose orprevent illness.

� Plant-based medicines (e.g., Herbal medicine) and Mineral-based medicines (e.g., zinc) - biologically-based therapies

� Manual therapies and exercises - manipulative and body-basedmethods

� Spiritual therapies – mind-body interventions

� Animal-based medicines – animals are very important part ofmany people’s lives and are a source of companionship and socialsupport

Complementary &

Alternative Medicine (CAM)

Broad set of health care practices that are not part of

a country’s own tradition and not integrated intoa 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’, ‘non-

conventional medicine’ and ‘holistic medicine’.

5 Major CAM Therapies1. 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 –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 –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 penetratethe human body,

� bioelectromagnetic-based therapies (magnetic fields/� bioelectromagnetic-based therapies (magnetic fields/magnet therapy)

5. Alternative medical systems – systems that arebuilt on complete systems of theory and practicethat 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 healthcare providers.

� There are a series of regulations and registration to control the safety,efficacy and quality of CAM remedies.efficacy and quality of CAM remedies.

� The TM/CM practitioners must receive a university education, whichincludes knowledge of both TM/CAM and modern medicine, and theymust be licensed to practice.

� Patients/ consumers are free to consult both TM/CAM providers andmedical doctors.

� The health insurance system covers both forms of treatment, and thereare no communication barriers between TM/CAM practitioners andmedical doctors.

� The government regulates actively the use and practice of TM/CAM andprovides 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,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/CAM1. Primary source utilization - TM/CAM is used as primary

source of health care (e.g., many African countries andsome Asian countries – areas where availability andaccessibility of conventional medicine is limited). Mainlyfound in a tolerant or an inclusive health care structure.found in a tolerant or an inclusive health care structure.

2. Dual utilization - Use and prescription of TM/CAM inconjunction with conventional medicine (e.g., China,Vietnam, Republic of Korea, many countries in Asia andSouth America). Mainly found in integrative or inclusivesystems.

3. Selective utilization – Use of TM/CAM in acomplementary or alternative role with conventionalmedicine (e.g., North America and many Europeancountries)

Philippines – Cancer Management

� Either an inclusive or tolerant health

structure

� Utilization of TM/CAM is selective,� 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 UP-PGH cancer patientsPGH 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 PatientsCAM 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 PatientsRank CAM Modality % Use

1 Vitamin 51

2 Herbal 41

3 Exercise 243 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 system4.00 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 treatment2.52 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 20Patient 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 p-

valueconv CAM

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