Digest Commentator(s): David Michael Langelier MD, FRCPC, Dip CSCN (EMG), Cancer Rehabilitation Fellow, Princess Margaret Hospital, University of Toronto
Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto
Background: The expectation of health care providers to understand and appropriately prescribe complementary therapies (CT) to cancer patients increases on an annual basis. Unfortunately, this increasing demand for physician competency in complementary services have not yet been appropriately reflected in the way physicians are trained. Therefore, when faced with a patient inquiring about various CTs, clinicians often look to clinical practice guidelines in order to safely and effectively prescribe outside their scope of knowledge. A recent article by Qureshi et al. highlights areas of CT interest to cancer outpatients and suggests particular CTs for future research and guideline development based on patient preferences.
Research Design: In April 2018, Qureshi et al. published an analysis into survivor’s interest and use of CTs. This involved a single centre cross-sectional survey of ambulatory cancer patients with no restrictions on tumor type, stage, or current treatment status. The study’s goals were to gather a more comprehensive picture of which CTs were being used, which were of highest interest, and whether particular physical symptoms, perceived stress, and spirituality were related to specific CT interest. The authors also examined barrier perception and whether clinical practice guidelines were available for CTs with the highest interest.
Results: Overall, 212 of 350 patients participated (60% response rate). Of these, 75% of patients had used CTs since their cancer diagnosis or were currently using CTs. The most frequently reported CTs were biologic (e.g. vitamins B12 and D, calcium) followed by mind/body (e.g. yoga, massage, mindfulness-based stress reduction), then energy-based (e.g. acupuncture) and alternative CTs (e.g. naturopathy). The largest perceived barriers were a lack of CT awareness and insufficient evidence on the CTs effectiveness. Lack of support from health providers contributed only minimally to CT use. In all CTs except cannabinoids, higher levels of perceived stress corresponded to higher levels of CT interest.
Why I liked this article: In the era of patient-centered-care, health care practitioners must acknowledge the high use of CTs and be attuned to which CTs are important to the patient. This article highlights the specific CTs requiring a research focus and this corresponds to the gap in available clinical practice guidelines. To fill this gap, guidelines are needed particularly in the areas of biologic (i.e. vitamin B12, vitamin D) and mind-body (i.e. breathing/relaxation) CTs. Additionally, as a health care provider this article flags patient awareness and education as two specific barriers the clinician could overcome with further education. Health care providers in oncology have a shared responsibility to know and share the evidence behind various CTs with patients, even if the evidence is limited.
Citation: Qureshi M, Zelinski E, Carlson LE. Cancer and Complementary Therapies: Current Trends in Survivors’ Interest and Use. Integrative Cancer Therapies. 2018 Apr 1:1534735418762496. DOI: 101177/1534735418762496.