Non-Pharmacologic Interventions in CancerComplementary and Alternative Medicine (CAM)Jeff Marc Bliss Billedo, SNHematology UnitTawam John Hopkins Hospital

Objectives Define Complementary and Alternative

Therapy. Identify nurses roles and responsibilities

involving Complementary and Alternative Medicine (CAM) use.

Understand the reasons why clients use CAM and know which ones help them.

Familiarize and understand the different CAM.

Complementary and Alternative Medicine Interventions that are supportive in nature and focused

on increasing well-being, healing, or management of symptoms.

Most often used in conjunction with conventional medical treatment.

May be categorized as those that focus on the following:1. The mind, body and spirit connection.2. Manual and energy healing and physical touch

techniques, including manipulation, movement, or touching the body and energy fields.

The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM.

National Center for Complementary and Alternative Medicine (NCCAM)

NCCAM's RoleNCCAM's mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. NCCAM achieves its mission through basic, translational ("bench-to-bedside"), and clinical research; research capacity building and training; and education and outreach programs.

National Institutes of Health established NCCAM.Purposes:Fund studies evaluating effectiveness of C.A.M.Advance health professional knowledge re: C.A.M.Serve as a clearinghouse for information about these therapies

NIH and NCCAM

Complementary Therapy Is used along with standard or mainstream medical

treatment/ conventional medicine. Some may help relieve certain symptoms of cancer, relieve side effects of cancer treatment, or improve a patients sense of well-being.

Alternative Therapy Is used instead of mainstream treatment. They are either

unproven because they have not been scientifically tested, or they have been disapproved.

Integrative Therapy Is a term often used to describe the combined use of

proven mainstream treatments and complementary methods.

QUACKERY and FRAUD

WHAT MAKES COMPLEMENTARY or ALTERNATIVE Therapies harder to evaluate?

1. The treatments are assumed to be safe

2. Some treatments are assumed to be effective

3. The expectation effect4. Good research studies take time

QUACKERY- refers to the promotion of methods that claim to prevent, diagnose, or cure cancer s that are not known to be false, or which are unproven and most likely false.

FRAUD- goes a step beyond quackery. In this case, treatments are advertised deceptively by people whose main intent is to make money.

Nurses must:1. Be non-judgmental despite personal opinions. 2. Build rapport by showing client respect – if not, he may

be afraid to tell about CAM use3. Understand that CAM can be beneficial, when used

correctly.4. Be aware that CAM can be dangerous if it interacts or

interferes with conventional treatment.5. Be willing to teach the public about the positive and

negative information regarding CAM.6. Be aware that use of CAM is popular and increasing and

must be included in the history & physical assessment.7. Know that herbals in particular, can have significant

effect on prescription drugs and body functions.

Reasons given by clients for using CAM. Helps to cope more

effectively with stress. Decreases discomforts of

treatment. Gives increased sense of

control. Improves quality of life. Relieves symptoms (e.g.

pain, nausea, fatigue, insomnia).

Complementary and Alternative Medicine Therapies Identified as Helpful by Clients with CancerTherapy Helpful * NumberSelf-help groups 100% 7Spiritual 94% 34Imagery 86% 8Massage 80% 5Exercise 67% 12Lifestyle diet 60% 5Relaxation 50% 22Herbal/Botanical 20% 5

Sparber A et al: Use of Complementary medicine by adult patients participating in cancer clinical trials, Oncology Nurs Forum 27(4):628, 2000 *Percentage reflects answers given as helpful/very helpful.

Types of CAM non pharmacologic interventions

1. Systems of Health Care

2. Mind-body therapies

3. Manipulative and body-based therapies

4. Biologically based therapies

5. Energy therapies

Types of CAM :Non-Pharmacologic Interventions

Mind-Body-Spirit techniques

Imagery,Meditation,Yoga,Aromatherapy,Hypnosis, Humor,Spirituality

Manipulative and Body based therapies

Massage,Reflexology,Chiropratic,Osteopathy

Manual or energy healing techniques

Acupressure,Acupuncture,Healing and Therapeutic touch

Biologically based approaches

Diet,Herbals,Vitamins

Energy therapies Reiki,Magnets,Qi gong

Alternative medical systems

Ayurveda,Naturopathy,Homeopathy,TCM

Prayer and Spirituality•Spirituality is generally described as an awareness of something greater than the individual self. It is often expressed through religion and/or prayer, but there are many other paths of spiritual pursuit and expression. •Prayer is the most Widely Used CAM in U.S. (NCCAM, 2004) •Prayer

•For Self•For Others•Healing Prayer Services•Prayer Groups

Meditation

• Stress relief/ reduce anxiety• Relaxation• Reduced levels of lactic acid• Decreased oxygen consumption• Slowed heart rate• Decreased blood pressure• Improved function of immune system• Reduce pain

Hypnosis

• An artificially induced alteration of consciousness characterized by increased suggestibility and receptivity to direction.

• It has been used to reduce anxiety, nausea, vomiting and pain and to promote healing.

Guided Imagery

• Distraction when confronting pain, discomfort or fear

• Making decisions and altering behavior

• Caution: not recommended for emotionally unstable or cognitively impaired client

• Reduction of nausea & vomiting and pain.

• Decreasing anxiety• Promoting comfort during

cancer treatment

Music

Considered a universal language and is used in combination with many approaches to enhance relaxation.

Studies support effectiveness of music as a non pharmacologic method of pain reduction by stimulating the release of endorphins.

Massage

• Within few minutes of massage, most people experience reduced blood pressure, reduced heart rate, endorphin release, slower, deeper, more effective breathing and reduction of muscular tension.

• Some studies suggests that it can decrease stress, anxiety, depression, and pain.

Reflexology

• A form of foot massage designed to harmonize body functions.

• Based on the concept that the whole person is interconnected and that imbalance in one part of the body is reflected in changes else where.

Acupressure

• Is based on the eastern concept that Qi, or energy, flows through the body in defined pathways called meridians.

• This energy can be blocked or stuck and pressing on specific points along the meridians or channels through which Qi is thought to flow can improve the flow and relieve imbalance.

Acupuncture

• Treatments involve leaving thin, sterile acupuncture needles in the skin for 20 minutes.

• It is a technique in which very thin needles are put into the body to treat a number of symptoms.

• It may help with mild pain and some types of nausea.

Aromatherapy

Lavender – promotes relaxation & sleep

Peppermint – stimulation, concentration

Sandalwood – ease depression Chamomile – relaxation Lemon – promotes sleep/ tx for

insomnia and/or digestive disorders

•Is the use of fragrant substances called essential oils that are distilled from plants to alter mood or improve symptoms such as:•Stress , nausea and anxiety•Muscular and rheumatic pains•Digestive disorders•Can be used for sense of smell, but also as compresses, baths or topical

Humor•Ability to see the humor in situations in life is a valuable health asset and can be cultivated even during serious illness such as cancer.•Laughing relaxes the nervous system, and the diaphragm moves up and down vigorously, emptying the lungs more completely than usual.

Signs of treatments to avoid1. Does the treatment promise for a

cure for all cancers?2. Are you told not to use

recommended or standard medical treatment?

3. Does the treatment claim to offer benefits, but no side effects?

4. Is the treatment or drug only offered by one person or clinic?

5. Do the promoters use terms like “scientific breakthrough”, “miracle cure”, “secret ingredient” or “ancient remedy”?

6. Are you offered personal stories of amazing results but no actual scientific evidence?

7. Do the promoters attack the medical or scientific community?

References:

• Itano, J.K., Taoka, K. N. (2005). Core Curriculum for Oncology Nursing

•http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/cancer-treatment/complementary-medicine/index.htm

•http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/complementary-and-alternative-methods-for-cancer-management•http://www.nccam.nih.gov/health/whatiscam

•http://www.pubmed.com