A Call to Action – Utilizing Patient Interest in Complementary Therapy as a Blueprint to Guideline Development

22 Jan 2019 3:58 PM | Anonymous

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

Digest Commentary

Background: The expectation of health care providers to understand and appropriately prescribe complimentary therapies (CT) to cancer patients increases on an annual basis. Unfortunately, this increasing demand for physician competency in complimentary services have not yet been appropriately reflected in the way physicians are trained. Therefore, when confronted 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. This article highlights areas of CT interest to patients and suggests particular CTs for future research and guideline development based on patient preferences.

Research Design: In April 2018, Qureschi et al. published a more extensive analysis into survivor’s interest and use of CTs in the journal of Integrative Cancer Therapies. This involved a cross-sectional survey of 212 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 certain interests. The authors also examined barrier perception and whether clinical practice guidelines were available for CTs with the highest interest.

Results: Overall, 75% of patients had used 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 participation. In all CTs except cannabinoids, higher levels of perceived stress corresponded to higher levels of CT interest.

Importance: In the era of patient-centered-care, health care practitioners must acknowledge the high use of CTs and be attune 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 awareness and further education as two specific barriers to CT involvement. 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 Complimentary Therapies: Current Trends in Survivors’ Interest and Use. Integrative Cancer Therapies. 2018 Apr 1:1534735418762496. DOI: 101177/1534735418762496.

Journal website: http://journals.sagepub.com/home/ict

Author Website: https://lindacarlson.ca/about

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