Integrative oncology in palliative medicine

Author(s):  
Gary Deng ◽  
Barrie Cassileth

Patients under palliative care, facing poor prognoses and a heavy symptom burden, often seek health-care practices and agents outside of mainstream medicine. Collectively these modalities often are termed ‘complementary and alternative medicine’ (CAM), to describe a diverse group of therapies that range from unproved alternative ‘cures’ offering false hope, to adjunctive complementary therapies that provide legitimate supportive care and that comprise integrative oncology. Although complementary therapies and alternative approaches are sometimes discussed under the single umbrella of CAM, it is clinically and conceptually necessary to distinguish between complementary and ‘alternative’ because they are profoundly different, and because there are no viable ‘alternatives’ to mainstream cancer care. The acronym is an easy but incorrect and counterproductive conflation of two unrelated approaches. This chapter summarizes the state of integrative medicine and medical oncology in the current health-care system. It discusses helpful complementary therapies applicable to palliative medicine and also describes the unproven alternatives that are widely proffered to patients and families internationally.

Author(s):  
Gary Deng ◽  
Barrie Cassileth

Integrative oncology, the diagnosis-specific field of integrative medicine, addresses symptom control with nonpharmacologic therapies. Known commonly as “complementary therapies” these are evidence-based adjuncts to mainstream care that effectively control physical and emotional symptoms, enhance physical and emotional strength, and provide patients with skills enabling them to help themselves throughout and following mainstream cancer treatment. Integrative or complementary therapies are rational and noninvasive. They have been subjected to study to determine their value, to document the problems they ameliorate, and to define the circumstances under which such therapies are beneficial. Conversely, “alternative” therapies typically are promoted literally as such; as actual antitumor treatments. They lack biologic plausibility and scientific evidence of safety and efficacy. Many are outright fraudulent. Conflating these two very different categories by use of the convenient acronym “CAM,” for “complementary and alternative therapies,” confuses the issue and does a substantial disservice to patients and medical professionals. Complementary and integrative modalities have demonstrated safety value and benefits. If the same were true for “alternatives,” they would not be “alternatives.” Rather, they would become part of mainstream cancer care. This manuscript explores the medical and sociocultural context of interest in integrative oncology as well as in “alternative” therapies, reviews commonly-asked patient questions, summarizes research results in both categories, and offers recommendations to help guide patients and family members through what is often a difficult maze. Combining complementary therapies with mainstream oncology care to address patients' physical, psychologic and spiritual needs constitutes the practice of integrative oncology. By recommending nonpharmacologic modalities that reduce symptom burden and improve quality of life, physicians also enable patients to play a role in their care. Critical for most patients, this also improves the physician-patient relationship, the quality of cancer care, and the well-being of patients and their families.


2009 ◽  
Vol 5 (2) ◽  
pp. 133-144 ◽  
Author(s):  
Patricia Geist-Martin ◽  
Catherine Becker ◽  
Summer Carnett ◽  
Katherine Slauta

The big island of Hawaii has been named the healing island – a place with varied interpretations of healing, health, and a wide range of holistic health care practices. This research explores the perspectives of holistic providers about the communicative practices they believe are central to their interactions with patients. Intensive ethnographic interviews with 20 individuals revealed that they perceive their communication with clients as centered on four practices, specifically: (a) reciprocity – a mutual action or exchange in which both the practitioner and patient are equal partners in the healing process; (b) responsibility – the idea that, ultimately, people must heal themselves; (c) forgiveness – the notion that healing cannot progress if a person holds the burden of anger and pain; and (d) balance – the idea that it is possible to bring like and unlike things together in unity and harmony. The narratives revealed providers’ ontological assumptions about mind-body systems and the rationalities they seek to resist in their conversations with patients.


Author(s):  
Jordana Muroff ◽  
Abigail Ross ◽  
Joseph Rothfarb

While cognitive-behavioral therapy (CBT) and pharmacotherapy are “gold standard” treatments for obsessive-compulsive disorder (OCD), complementary and alternative treatments are frequently sought for anxiety disorders. The purpose of this chapter is to review and discuss the available research on the application, efficacy and effectiveness of complementary and alternative methods for treating OCD. The first section identifies and reviews studies focusing on specific alternative and complementary treatments that are independent from, or work in conjunction with CBT, such as yoga, herbal remedies, motivational strategies, and bibliotherapy. The second section discusses alternative and complementary methods of more mainstream CBT and related techniques, with a particular focus on technology-supported approaches. The chapter concludes with a discussion of the methodological issues in the existing research on complementary and alternative methods in the treatment of OCD, questions for future research, and implications for providers.


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