Complementary and Alternative Therapies Flashcards
1
Q
Types of Complementary and Alternative Therapies
A
- Mind-body
- Biologically based practices
- Manipulative and body-based practices
- Energy therapies
- Whole medical systems
2
Q
CAM: Mind-body therapies
A
- Focus on mind’s ability to influence physiology and WOL
- Sustained attention-focussed techniques, emotionally expressive and imaginative practices
Examples:
- Hypnosis
- Imagery
- Mindfullness
- Biofeedback
- Yoga
- Meditation
- Music
- Art therapies
3
Q
CAM: Biologically based practices
A
- Use natural health products for ingestion, injection, topical application, or inhalation
Examples
- Vitamins
- Minerals
- Nutraceuticals
- Herbal products
4
Q
CAM: Manipulative and body-based practices
A
- Involve physical touch of the patient’s body
Examples:
- Massage
- Chiropractic techniques
5
Q
CAM: Energy therapies
A
- Based on conceptualization of the physiological body as consisting of energy fields which can be influenced through various techniques
Examples:
- Therapeutic touch (not physical touch)
- Reiki (involves touching, Japanese origin)
- Healing touch
- Qigong (Chinese practive)
- Magnetic therapy
- Acupuncture/acupressure
6
Q
CAM: Whole medical systems
A
- Comprehensive systems of therapy and practice developed prior to or in parallel to conventional medicine
- Traditional Chinese medicine
- Ayurvedic medicine
- Naturopathy
- First Nations Healing
7
Q
CAM use in cancer - Associations
A
- Higher prevalence of use than in other types of patients
- Women with gyne and breast cancers have the highest use, followed by men with prostate cancer
Associated factors:
- Younger age
- Higher educational level
- Higher SES
- Perceived risk of recurrence
- More advanced disease
- Ethnocultural background where traditional health systems are part of mainstream care
8
Q
CAM use in cancer
A
- Rarely a single modality, rather most patients combine therapies
- Most use CAM as an adjunct to conventional tx
- Less than 10% forego conventional treatments in favour of CAM alone
9
Q
Reasons for CAM use
A
- Mitigate side effects of cancer treatment
- Restore balance
- Reduce energy levels
- Foster wellness
- Perceived benefit
- Strong belief
- Last resort measure
- Way to find hope
- Dissatisfaction with quality of care providers in mainstream healthcare
- Sense of control or ability to be pro-active
10
Q
Sources of information on CAM
A
- Friends/relatives
- Literature/Internet
11
Q
Approaching CAM with patients
A
- Ask patient about main symptoms addressed
- Ask patient to maintain a daily symptom diary (pre and post treatment comparison)
- Discuss the patient’s preferences/expectations regarding CAM
- Review safety and efficacy of options - discourage any intervention that delays, negates, or accentuates the adverse effects of conventional treatments with proven efficacy
- Encourage patient to review professional credentials of a CAM provider
- Provide patients with questions to ask the CAM provider (what the therapy is, frequency of visits, costs, time frame for benefit, potential side effects, willingness to communicate findings/plans with conventional care providers)
- Schedule follow up to review progress
- Follow up and review response to tx
- Document
12
Q
Evidence based resources on CAM
A
cam-cancer.org
naturaldatabase.com
National Centre for Complementary and Integrative Health (nccih.nih.gov)
13
Q
Patients asking if herbs are “all natural” and therefore “safe” and the accuracy of labels/content of products
A
- Quality and standardisation may vary considerably between products (even with the same label)
- Quality requires correct botanical identification, prevention of contamination, adulteration, and accuracy of labelling of potency/strength
- Standardisation requires comparable and replicatable doses of compounds in each dose of herb, which is difficult with plants in which chemical composition may vary occurring to growing conditions, harvesting and drying process, extraction and concentration, etc. - Regulation
- In Canada, regulated as ‘natural health products’ if herbs are endorsed as preventing, diagnosis, treating disease, maintaining/promoting health, or self-care
- Requires pre-market approval by Health Canada
- Involves site licenses and manufacturing standards
- Check for a Natural Product Number (NPN) or Homeopathic Number: DIN-HM
14
Q
Natural health side effects
A
Possible side effects/interactions:
- Antiplatelet activity
- Interact with steroids and CNS depressants
- Hepatotoxicity
- Nephrotoxicity
- Additive effects when used with analgesics
- Most commonly, allergic reactions (hives, itching, swelling) or GI side effects (N/V, constipation, etc.)
15
Q
Natural products concurrent with chemo or rads
A
- Drug-herb interactions
- All antioxidants could reduce biological impact of rads
- Risk of inducing CYP isoforms (subtherapeutic plasma concentrations of other drugs)
- Risk of inhibiting CYP isoforms (supratherapeutic plasma concentrations and toxicity) - Additive effects (some argue)
- Selected AM with chemo/rads could be helpful as antioxidant therapy reduces oxidative stress (growth inhibiting) and increase responsiveness to chemo
- Some studies suggest decreased chemo/rads toxicities with antioxidant supplements
Given how little is known, best to advise patients to AVOID natural health products while receiving chemo/rads.
