Complementary and Alternative therapies Flashcards
List different categories of CAM
- Mind-body (hypnosis, midnfulness, meditation)
- Biologically based (herbs, vitamins, nutraceuticals)
- Manipulative (massage, chiro)
- Energy therapies (reiki, qigong, acupuncture)
- Whole medical systems (chinese, ayurvedic, naturopathy)
Who is likely to use CAM in cancer?
- women with gyne and breast cancers
- men with prostate ca
- younger age
- higher educational level
- higher SES
- perceived high risk of recurrence
- ethnocultural background with common mainstream alternative health systems
Reasons why someone would use CAM
- treat side effects of cancer treatment
- restore balance
- energy
- wellness
- perceived benefit
- strong belief
- hope
- dissatisfaction with mainstream medicine
- sense of control
List steps in discussing CAM with patients
- Ask pt about symptoms
- Ask patient to maintain sx diary (pre and post treatment)
- Discuss patient preferences and expectations re: CAM
- Review safety and efficacy of options
- Encourage pt to review credentials of CAM provider
- Provide pt with questions to ask CAM provider
- Schedule follow up to review
- Follow up
- Document
How do you respond to patients asking about herbs being all natural and safe and accuracy of labels/content?
Quality control
- Quality and standardization vary
- need correct botanical ID, no contamination, adulteration, accuracy
- need standardization of dosage /potency
- botanicals / herbs : vary acc to growing conditions, harvesting, drying, extraction, etc
Regulation
- in Canada “natural health product” regulated
- Health Canada approval required
- Site licenses and manufacturing standards
- Natural Product Number (NPN) or Homeopathic Number (DIN-HM)
General side effects of some naturopathic products
- antiplatelet activity
- interactions with steroids and CNS depressants
- hepatotoxicity
- nephrotoxicity
- analgesic interactions
- allergic reactions
What about using natural products with chemotherapy or radiation therapy?
- Drug-herb interactions
- antioxidants reduce impact of radiation
- CYP interactions (inducing or inhibiting)
- Additive effects?
- may work WITH radiation/chemo to improve responsiveness
- decreased toxicity from chemo/rad
- Little is known, recommend AVOIDING CAM products during chemo/rad.
How does acupuncture work to relieve pain?
- stimlates small afferent sensory muscle nerves that go to spinal cord
- relays to subcortical nuclei, limbic system adn pituitary gland
- activation of relay path blocks pain transmission
What is the evidence for acupuncture for management of CINV and dyspnea?
- poor quality studies
- limited
- mixed
- most patients get some benefit, but duration of response variable
When to avoid acupuncture?
- thrombocytopenia
- bleeding disorders
- cachexia
- low ANC not a Contraindication
- avoid in limbs with lymphedema
- avoid electroacupuncture if PM /ICD
- cellulitis
Is there evidence for meditation, hypnosis, guided imagery?
- mixed
- good evidence for mind body therapies. mindfulness
- reduces anxiety, mood disturbancem chronic pain, inc QOL
List components of relaxation techniques
- repetitive focus on word, wound, image, phrase, prayer, body sensation
- passive attitude toward intruding thoughts, then return to focus.
What can meditation be useful for (evidence)
- pain
- distress
- sleep
- QOL
- anxiety, depression
Use of hypnotherapy - evidence
- management of cancer pain
- CINV
Massage
Systematic review:
- anxiety
- pain
- depression
- stress
- fatigue
lack of vigorous research
avoid deep pressure near lymph nodes or bone
if bleeding diathesis, light massage only
