Complementary and alternative medicine, for reasons varying from a desire to control symptoms and prevent and treat cancer to high accessibility, has assumed significant importance in cancer treatment and care for many patients. An estimated 14% to 65% of Australian adult cancer patients use complementary and alternative medicine (compared with up to 80% to 91% in Europe and the US). Cancer patients who use complementary and alternative medicine are typically female, younger, more educated and of higher socioeconomic status. Moreover, 33% to 77% of patients do not disclose complementary and alternative medicine use to their physicians. Particular complementary and alternative medicine (eg. herbal medicines, nutritional supplements) have drawn steadfast opposition from clinicians, primarily because they remain unproven in clinical trials. However, some complementary therapies (eg. relaxation, massage) used as adjuncts to conventional medical treatments have proven beneficial in reducing disease or treatment symptoms and improving quality of life and psychological functioning in high quality cancer clinical trials. Nevertheless, cancer patients problematically perceive complementary and alternative medicine as more ‘natural’ and safer than conventional treatments. Indeed, there is evidence of harm. Herbal medicine, nutritional supplements and other natural therapies, for instance, may pose direct safety risks because of their potential adverse effects or interactions with conventional anti-cancer treatments and other medications. Consequently, some complementary therapies should not be used under any circumstances irrespective of potential benefit (eg. St John’s wort), while others may be beneficial when cancer patients are not undergoing conventional treatments and have no other contraindications. Complementary and alternative medicine may also cause indirect harm (eg. resultant delays in conventional treatment potentially compromise treatment outcomes, quality of life and survival). It is therefore imperative that those involved in the medical care of cancer patients are equipped with the skills and knowledge to help patients appropriately evaluate complementary and alternative therapies. Additionally, due to the safety risks involved, clinicians are strongly encouraged to routinely ask patients about complementary and alternative medicine use. In conclusion, whether termed integrative cancer care or complementary medicine, health professionals in Australia should strongly consider offering evidence-based complementary therapies (or at least safe forms of them) alongside conventional treatments through their own cancer services. Conceivably, this will influence patients to continue with mainstream care and help them avoid any potential harm that may occur with autonomous complementary and alternative medicine use. In this way, optimal holistic care will be ensured for cancer patients by clinicians providing conventional oncology treatment and care.
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