Critique 2: Complementary and Alternative Medicine in Pediatric Oncology

A research program in CAM and childhood cancer is essential. This proposal has made a strong beginning by summarizing the literature, providing a conceptual model in which to evaluate CAM, and detailing the issues to be considered in developing research studies in CAM. The next steps should include the development of a system to prioritize areas for research in CAM in the cooperative group and strategies to enhance patient recruitment to such trials. The research has great significance given the ever-increasing numbers of children using CAM during cancer treatment. The researchers are to be commended for their initial efforts to develop this research agenda.     

Complementary and alternative medicines for use in supportive care in pediatric cancer

Introduction Complementary and alternative medical practices (CAM) are being used by increasing numbers of children with cancer. Discussion Recent surveys report CAM use prevalence rates of 24–90% in children with cancer. Interest in supporting children through the side effects or stress of conventional treatment has been described as one of the major motivating factors for the use of CAM therapies. Research is difficult secondary to the complexity of the therapies and lack of standardization. However, several research studies investigating CAM therapies for supportive care in children with cancer are ongoing. Information on several studies in progress through the Children’s Oncology Group and other institutions will be reviewed. Conclusion The progress made in the development of these studies demonstrates that CAM therapies can be investigated for their supportive care roles in the therapy of children with cancer. Presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto, Canada, June 2006.     

Critique 1: Complementary and Alternative Medicine in Pediatric Oncology

Research on CAM therapies in pediatric cancer patients is in its infancy and more research is clearly warranted given the high use of CAM therapies and the largely unknown benefits, toxicities, and interactions. To obtain adequate sample sizes, multi-site research is necessary. Multi-site research in this area is challenging, but the challenges are not insurmountable. Careful design and attention to the unique issues of conducting multi-site CAM research in pediatric cancer patients would be a worthwhile undertaking with the potential for valuable, clinically significant outcomes.     

Complementary and alternative medicine (CAM) and supportive care in cancer: a synopsis of research perspectives and contributions by an interdisciplinary team

Goals of work The purpose of this short review is to provide a commonly accepted definition of complementary and alternative medicine (CAM), to illustrate the widespread use of CAM by people affected by cancer around the world, and to highlight the research contributions of the Cancer Complementary and Alternative Medicine (CCAM) research team and its colleagues. Methods Based on research conducted by CCAM and several European colleagues, a collection of articles was compiled, reviewed, and edited. Main results CAM modalities play a role in supportive care and cancer. Because of the high CAM utilization, it is critical to help cancer patients make safe, informed, evidence-based decisions for their care. In addition, advances in research methodology, outcomes, and measurement in CAM studies are suggested to better account for individual and collective experiences. Conclusion This special issue provides clinicians with a summary of information about CAM and perspectives for better responding to cancer patient’s needs.     

Complementary and alternative medicine for noncancer pain

In summary, the past several years have shown an increase in the quality of trials examining the clinical efficacy of various CAM modalities for pain conditions. There is still need to raise the quality of the studies from a scientific and methodological point of view in many areas of CAM research by randomization, appropriate sample size, blinding, and developing more sophisticated sham procedures. However, much work still has to be done to find ways to preserve the clinical authenticity of CAM treatment methods when brought into the light of a research protocol. Recent attempts have been made to find a method of maintaining the standardization and reproducibility of research protocols while allowing the kind of flexible treatment that would normally be applied in a clinical setting. Other questions that should be answered with future studies include understanding how treatment length influences outcome, if maintenance treatments are needed for chronic conditions, and cost and risk comparisons with standard pharmacological treatment. Providing this kind of detail will assist both with reproducibility as well as help us gain a better understanding about whether certain treatment paradigms are superior to others for specific clinical conditions. Finally, physicians who have an interest in pursuing CAM research should educate themselves both about the methodological issues inherent with the particular area of interest as well as about ways to maintain the authenticity of the CAM treatment protocols so that the literature is not populated with more poorly designed studies. With the emerging interest in integrative medicine, there is a growing interest in collaboration and a greater number of physicians are interested in obtaining training in CAM modalities to help bridge this gap between CAM and conventional clinicians. For example, the American Academy of Medical Acupuncturists (AAMA) has been formed to help as both an educational and research forum for physician acupuncturists and the American Holistic Medical Association provides educational exposure in a broad range of Integrative and CAM modalities. The future of medicine will likely be Integrative and the more health care providers can educate themselves about this area of medicine, the better they will be able to provide the highest quality of care to their patients.     

The National Cancer Institute's perspective and agenda for promoting awareness and research on alternative therapies for cancer

The widespread use of a variety of nutritional, psychologic, and natural medical approaches, collectively termed complementary and alternative medicine (CAM), has been well documented. Recent surveys demonstrate that between 9% and 91% of U.S. patients with cancer use CAM therapies at some time after their diagnosis. However, there is a paucity of data available to indicate whether these CAM practices are efficacious and safe. Despite, or possibly because of, this controversy there has been considerable growth of interest in CAM by the American public. This interest has also resulted in a growth of research resources. Concurrently there has been an expansion of interest in the conventional medical establishment manifested by the creation of Departments of CAM or Integrative Medicine in respected conventional medical institutions, privately funded research centers and the National Institutes of Health (NIH) Office of Alternative Medicine (OAM)/National Center for Complementary and Alternative Medicine (NCCAM). Communication between conventional and unconventional practitioners is beginning. These changes are leading to a conversion of the dialogue about CAM from a focus on "quackery" to an exploration of the potential for novel therapeutics and the beginnings of focused, rigorous research. The National Cancer Institute is establishing programs to increase the amount and quality of CAM cancer research, support the production of high-quality CAM cancer information, and facilitate the dialogue between CAM practitioners and cancer researchers.     

Presenting the alternative: cancer and complementary and alternative medicine in the Canadian print media

Goals of work Cancer patients repeatedly identify the mass media as a primary information source to support their decisions to use complementary and alternative medicine (CAM). Accordingly, the objectives of this research are to describe: (1) what has been reported in the Canadian print media regarding CAM treatment for cancer between January 1, 1990 and December 31, 2005; (2) how that information was represented; and (3) trends in reporting frequency and reporting characteristics. Materials and methods Content analysis of all articles published in four Canadian newspapers and five magazines that discussed CAM treatment for cancer. Main results 915 articles were identified: 760 newspaper articles and 155 magazine articles. The CAM therapies most commonly described in media reports were: natural health products, CAM therapies in general, special diets, spirituality, and meditation. CAM therapies were most often described in a positive fashion, and CAM use was most often described as a potential cure for cancer. The majority of articles did not present information on the risks, benefits, and costs of CAM use and few provided a recommendation to speak with a health care provider before use. Conclusions The results correspond with the commercial interests of media outlets, as coverage appears to be focused around entertainment rather than information provision. The media play a role in introducing a range of treatment options to cancer patients that may not be discussed by conventional health care providers; however, the information provided in media articles appears insufficient to assist patients with informed decision-making.     

Complementary and Alternative Medicine Approaches for Pediatric Pain: A Review of the State-of-the-science

In recent years, the use of complementary and alternative medicine(CAM) in pediatric populations has increased considerably, especiallyfor chronic conditions such as cancer, rheumatoid arthritisand cystic fibrosis in which pain may be a significant problem.Despite the growing popularity of CAM approaches for pediatricpain, questions regarding the efficacy of these interventionsremain. This review critically evaluates the existing empiricalevidence for the efficacy of CAM interventions for pain symptomsin children. CAM modalities that possess a published literature,including controlled trials and/or multiple baseline studies,that focused on either chronic or acute, procedural pain wereincluded in this review. The efficacy of the CAM interventionswas evaluated according to the framework developed by the AmericanPsychological Association (APA) Division 12 Task Force on Promotionand Dissemination of Psychological Procedures. According tothese criteria, only one CAM approach reviewed herein (self-hypnosis/guidedimagery/relaxation for recurrent pediatric headache) qualifiedas an empirically supported therapy (EST), although many maybe considered possibly efficacious or promising treatments forpediatric pain. Several methodological limitations of the existingliterature on CAM interventions for pain problems in childrenare highlighted and future avenues for research are outlined.     

Complementary and alternative medicine in pediatric oncology.

Children with cancer and their families use complementary and alternative medicine (CAM) to reduce symptoms, cope with life-threatening illness, and improve overall well-being. Despite numerous published surveys on the use of CAM in pediatric oncology, few studies have tested CAM therapies for safety and efficacy. A growing body of literature in adult oncology provides evidence for the role of CAM to help manage symptoms and reduce distress. Translating this research to children requires studies with new models that address family roles and include measurement of outcomes relevant to children's developmental stages and unique responses. One of the limitations in pediatrics is the small samples available to single institutions. Conducting clinical trials through the cooperative group mechanism is one way of obtaining sufficient sample sizes to determine effectiveness and safety of CAM therapies. This article summarizes research to date and describes a beginning approach to measuring outcomes of supportive CAM therapies in children with cancer.     

Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well‐being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno‐nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.     

Complementary and alternative medicine in pediatric oncology

OBJECTIVES: To summarize research in complementary and alternative medicine (CAM) therapies used for children with cancer and to explore issues and directions for measuring outcomes of CAM therapies in children. DATA SOURCES: Scientific and research articles, internet for active research studies. CONCLUSION: CAM is increasingly used as adjunctive cancer therapies in pediatrics. Mind-body and touch therapies have the greatest evidencefor effectiveness in reducing psychological and physical stressors. Supplements and herbal therapies receive the greatest interest, however, and more research is needed to determine efficacy in improving symptoms or outcomes in children with cancer. IMPLICATIONS FOR NURSING PRACTICE: Mind-body and touch therapies can be used by nurses to reduce symptoms and anxiety in children. Potential risks and benefits should be determined for therapies that have no evidence.     

Biofield therapies and cancer pain

The public and healthcare professionals have become increasingly aware and accepting of the benefit in physical, psychological, social, and spiritual support for patients with cancer. Patients with cancer often seek nonpharmacologic interventions to complement conventional care and decrease the pain associated with cancer and its treatment. Most often referred to as complementary and alternative medicine (CAM), these supportive therapies consist of a heterogeneous group of modalities used as adjuncts to allopathic health care. Biofield therapies are CAM modalities that involve the direction of healing energy through the hands to facilitate well-being by modifying the energy field of the body. This critical review of studies of biofield therapies emphasizes research using these modalities to decrease pain in patients with cancer. Although the therapies have demonstrated clinical efficacy, additional research is warranted. Oncology nurses should familiarize themselves with biofield therapies so they can offer informed recommendations to patients with cancer experiencing pain.     

Complementary and alternative medicine use among breast cancer survivors

OBJECTIVES: The use complementary and alternative medicine (CAM) by patients with breast cancer and survivors has been widely studied. However, scant research has focused on the degree to which CAM activity is related to the cancer experience, as opposed to use for other reasons. The study objective was to examine the use of CAM in a sample of patients with breast cancer. Additional objectives were to measure associations between psychosocial and medical factors and CAM use both related and unrelated to a breast cancer diagnosis. DESIGN: Breast cancer survivors (N=115) at least 1 year beyond active medical treatment were recruited during routine clinic visits. Survey data collected via structured telephone interview focused on CAM use, motivations for use, perceived risk of cancer recurrence, and breast cancer-specific and general measures of anxiety. RESULTS: Sixty-nine percent (69%) of participants reported use of CAM. Of CAM users, 73% reported initiating or changing CAM activity specifically because of their cancer diagnosis. Patients engaging in CAM for cancer-related reasons were younger (p<0.001) and had been diagnosed with cancer at a younger age (p<0.01). Although overall anxiety scores in this sample were not significantly elevated, higher trait anxiety was associated with CAM use related to one's cancer diagnosis. CONCLUSIONS: Rate of CAM use was high, with the majority of CAM users associating that activity with their breast cancer. Anxiety levels varied between nonusers, CAM users for cancer, and CAM users for other reasons, with highest trait anxiety among those who associate their CAM use with cancer. Assessing motivations for CAM use may be important in future examinations of the relationship between CAM use and quality of life among breast cancer survivors.     

Research methodology: implications for CAM pain research

The National Cancer Institute's Office of Cancer Complementary and Alternative Medicine established a series of expert panels to develop the state of the science in research methodologies in CAM cancer research. Panelists from both conventional and CAM research draw on their expertise in their relative fields to apply their knowledge and expertise to specific topic areas within cancer CAM. The first panel is focused on cancer symptom research. The discussion and conclusions raised by this panel primarily address pain research but are applicable to other symptoms as well. This article will focus on the panel presentations that are most applicable to CAM pain research in both cancer and noncareer pain populations, identifying the major challenges and conclusions offered by the panelists.     

Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use

Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.     

Future directions of CAM research in pediatric oncology.

Children with cancer are using complementary and alternative medicine (CAM) to relieve symptoms, reduce side effects of treatment, and cope with the emotional aspects of having a life-threatening illness. Parental decisions about using CAM should be based on studies of efficacy and safety. Unfortunately, little evidence of efficacy is available for the majority of CAM therapies. This article discusses the methodological challenges to conducting CAM research in children and the evidence needed to support integrative medicine in pediatric oncology.     

The use of complementary and alternative medicine among california adults with and without cancer

This article examines the extent and correlates of complementary and alternative medicine (CAM) use among a population-based sample of California adults that is highly diverse in terms of sociodemographic characteristics and health status. As a follow-up to a state-wide health survey of 55,428 people, 9187 respondents were interviewed by phone regarding their use of 11 different types of CAM providers, special diets, dietary supplements, mind-body interventions, self-prayer and support groups. The sample included all participants in the initial survey who reported a diagnosis of cancer, all the non-white respondents, as well as a random sample of all the white respondents. The relation of CAM use to the respondents' demographic characteristics and health status is assessed. CAM use among Californians is generally high, and the demographic factors associated with high rates of CAM use are the same in California as have been found in other studies. Those reporting a diagnosis of cancer and those who report other chronic health problems indicate a similar level of visits to CAM providers. However, those with cancer are less likely to report using special diets, and more likely to report using support groups and prayer. Health status, gender, ethnicity and education have an independent impact upon CAM use among those who are healthy as well as those who report suffering from chronic health problems, although the precise relation varies by the type of CAM used.     

Introduction to the research methods in CAM series

There is increasing awareness of a need for rigorous research into complementary and alternative medicine, but as yet, limited guidance has been given to researchers, practitioners and students as to the range and scope of the various methodologies available and how existing methods can be modified for CAM research. This research methods series provides an outline of the main methods for researching CAM-related issues, including clinical trials, cross-sectional studies and qualitative methodologies. Drawing on the experiences of a range of experts in CAM research, each article in this series addresses the scope and strengths of a particular methodological approach. This series aims to convey the basis and objectives of particular methodologies within the context of CAM research, and thus, each paper will draw on actual examples of CAM research. It is intended to be of value both to inexperienced researchers and to those who are more experienced but are looking to broaden their range of knowledge. In this introduction, we outline some of the fundamental concepts for researching CAM, providing an overall sense of where each methodological approach outlined in this series fits in the 'order of things'. We outline different design strategies, the philosophical differences underpinning particular approaches to collecting data, and the issue of bias in research design and analysis.     

Integrative oncology research in the Middle East: weaving traditional and complementary medicine in supportive care

Introduction  

Complementary and alternative medicine (CAM) has an important role in supportive cancer care in the Middle East and is often used in association with traditional medicine. This article provides a comprehensive review of published data on CAM research in supportive cancer care in the Middle East.     

Evidence-based research in complementary and alternative medicine II: the process of evidence-based research

It is a common practice in contemporary medicine to follow stringently the scientific method in the process of validating efficacy and effectiveness of new or improved modes of treatment intervention. It follows that these complementary or alternative interventions must be validated by stringent research before they can be reliably integrated into Western medicine. The next decades will witness an increasing number of evidence-based research directed at establishing the best available evidence in complementary and alternative medicine (CAM). This second paper in this lecture series examines the process of evidence-based research (EBR) in the context of CAM. We outline the fundamental principles, process and relevance of EBR, and its implication to CAM. We underscore areas of future development in EBR. We note that the main problem of applying EBR to CAM at present has to do with the fact that the contribution of EBR can be significant only to the extent to which studies used in the process of EBR are of good quality. All too often CAM research is not of sufficient quality to warrant the generation of a consensus statement. EBR, nevertheless, can contribute to CAM by identifying current weaknesses of CAM research. We present a revised instrument to assess quality of the literature.