Complementary treatments have become a popular (and ‘political correct’) option to keep desperate cancer patients happy. But how widely accepted is their use in oncology units? A brand-new article tried to find the answer to this question.
The principal aim of this survey was to map centres across Europe prioritizing those that provide public health services and operating within the national health system in integrative oncology (IO). A cross-sectional descriptive survey design was used to collect data. A questionnaire was elaborated concerning integrative oncology therapies to be administered to all the national health system oncology centres or hospitals in each European country. These institutes were identified by convenience sampling, searching on oncology websites and forums. The official websites of these structures were analysed to obtain more information about their activities and contacts.
Information was received from 123 (52.1 %) out of the 236 centres contacted until 31 December 2013. Forty-seven out of 99 responding centres meeting inclusion criteria (47.5 %) provided integrative oncology treatments, 24 from Italy and 23 from other European countries. The number of patients seen per year was on average 301.2 ± 337. Among the centres providing these kinds of therapies, 33 (70.2 %) use fixed protocols and 35 (74.5 %) use systems for the evaluation of results. Thirty-two centres (68.1 %) had research in progress or carried out until the deadline of the survey. The complementary and alternative medicines (CAMs) more frequently provided to cancer patients were acupuncture 26 (55.3 %), homeopathy 19 (40.4 %), herbal medicine 18 (38.3 %) and traditional Chinese medicine 17 (36.2 %); anthroposophic medicine 10 (21.3 %); homotoxicology 6 (12.8 %); and other therapies 30 (63.8 %). Treatments are mainly directed to reduce adverse reactions to chemo-radiotherapy (23.9 %), in particular nausea and vomiting (13.4 %) and leucopenia (5 %). The CAMs were also used to reduce pain and fatigue (10.9 %), to reduce side effects of iatrogenic menopause (8.8 %) and to improve anxiety and depression (5.9 %), gastrointestinal disorders (5 %), sleep disturbances and neuropathy (3.8 %).
As so often with surveys of this nature, the high non-response rate creates a problem: it is not unreasonable to assume that those centres that responded had an interest in IO, while those that failed to respond tended to have none. Thus the figures reported here for the usage of alternative therapies might be far higher than they actually are. One can only hope that this is the case. The idea that 40% of all cancer patients receive homeopathy, for instance, is hardly one that is in accordance with the principles of evidence-based practice.
The list of medical reasons for using largely unproven treatments is interesting, I think. I am not aware of lots of strong evidence to show that any of the treatments in question would generate more good than harm for any of the conditions in question.
What follows from all of this is worrying, in my view: thousands of desperate cancer patients are being duped into having bogus treatments paid for by their national health system. This, I think, begs the question whether these most vulnerable patients do not deserve better.
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My mum has recently started on a course of chemotherapy for pulmonary adenocarcinoma at our local hospitals chemotherapy suite. I was quite surprised to see a leaflet offering homeopathy as just one of a range of complementary therapies available to the patients attending the unit for treatment, although as best as I could tell, none of the medical or nursing staff were actively recommending such therapies to the patients undergoing the treatment in the unit. The leaflet did try to suggest that such therapies had some evidence to support them, quoting some study or another, but did not offer any details that I can recall.
Much as I agree with you regarding the unscientific nature and unevidenced basis of claims of benefit for homeopathy, or reiki or whatever – If the patients are being treated with the best, NICE -approved therapies, does it then truly matter if some patients ask for, or accept some offered homeopathic “treatment” as an adjunct to their chemotherapy, if it makes them feel better, or if they gain some measure of comforting placebo effect?
I know that by not challenging such complimentary services, it might allow unscientific ideas to continue, and that it might have a cost to the health service – money that might be better spent elsewhere within the health service, supporting some evidence-based interventions – but still, part of me says that if such twaddle helps a patient through what is usually a most unpleasant experience, then that is fine really.
thank you; this is a good question.
after thinking long and hard about it for years my answer is as follows: yes, non-evidence-based therapies are harmful, even if they help some patients to go through a very difficult period. if evidence-based treatments were applied to treat the problems at hand and if that was done with kindness, compassion, empathy, time, dedication etc. the patient would benefit more – namely from the non-specific effects of the encounter and the specific effects of the therapy. in addition, we would not run the danger of promoting quackery that subsequently might be used under less appropriate circumstances, e. g. as a replacement of curative therapies.
“If … twaddle helps a patient through … then that is fine really.”
I see this as an important point. We are psychologically complex beings, and there’s no doubt that the way a sick person feels may contribute to the rate of resolution or non-resolution of that disease. So why shouldn’t a sick person grasp any form of nonsense they choose if they feel it helps them?
Part 1 of my answer is that the situation — a sick person — has, for thousands of years, attracted the attention of individuals who seek to profit financially by peddling twaddle for financial gain. In many cases (see this entire blog for examples) this leads to the establishment of organized twaddle industries. Their practitioners often like to call the industries “professions”, but that denigrates the function of professions that use reason and evidence to support their work.
Part 2 of my answer is that human culture has grown up over many millenia. It has become ever more adept at distinguishing truth from self-delusion. Part of the price we pay for that improvement is surely to rid ourselves of the delusions as swiftly as we can. There is still a flat-earth society in existence, huge numbers of people believe that astrologers (another “profession”) can predict their futures, and we read reports of religiously superstitious people undergoing exorcisms and worse because they believe individuals are possessed by demons. Do these kinds of twaddle reflect a society that values education and reason?
Part 3 of my answer — probably the most important — is the one already addressed by Edzard Ernst. If people delude themselves that the twaddle is superior to the ability of current medical science to address their disease to the point they refuse the latter (and I’m not talking here about the “worried well”) then they may be shortening their potential for cure or at least prolongation of their own survival. You may argue that’s fine: the Darwin Awards cover the situation well. But a humane society should take all reasonable steps to protect its individuals from the consequences of their personal idiosyncracies. We do this in so many walks of our lives: why do we except medical care from the list?
“… and there’s no doubt that the way a sick person feels may contribute to the rate of resolution or non-resolution of that disease.”
http://www.sciencebasedmedicine.org/nih-funds-training-in-behavioral-intervention-to-slow-progression-of-cancer/
http://www.sciencebasedmedicine.org/questioning-whether-psychotherapy-and-support-groups-extend-the-lives-of-cancer-patients/
There is plenty of doubt.
I stand corrected. All the more reason, then, for eradication of twaddle.
Edzard wrote ‘ if evidence-based treatments were applied to treat the problems at hand and if that was done with kindness, compassion, empathy, time, dedication etc. the patient would benefit more.’
This seems to be implying that currently evidence based treatments are not applied with ‘kindness, compassion, empathy, time, dedication.’
this would be a most misleading conclusion from what I did write.
Such Dogma smells of fear. How could one person claim to know and understand so much about such vast swaths of information?. You are akin to the religious henchmen of the dark ages, who cut down anyone who did not tow the party line.
who pays your bonus at christmas one wonders!
> who pays your bonus at christmas one wonders!
If you know one, please tell me. I am really looking for some organisation paying me a bonus for being a homeopathy-critic. Please give name and address so I may file my application.
Thanks in advance.
EE wrote: “The list of medical reasons for using largely unproven treatments is interesting, I think. I am not aware of lots of strong evidence to show that any of the treatments in question would generate more good than harm for any of the conditions in question.
What follows from all of this is worrying, in my view: thousands of desperate cancer patients are being duped into having bogus treatments paid for by their national health system. This, I think, begs the question whether these most vulnerable patients do not deserve better.”
Well, just an FYI, there is no strong evidence for any of today’s “scientific” cancer treatments, either. Some slight improvement in childhood leukemias and testicular CAs. But overall the outlook is still pretty dismal.
Surgery is fine, usually works well. But chemo and radiation are used by 99.9+% of desperate cancer patients and over 500,000 die each year in the U.S. who are on these “proven” methods. Go to 100 different hospitals in different cities or different countries, you get 100 different protocols. “More good than harm!” That’s a good one, EE. It is all a big guess.
So, EE, if you did a survey, you might find that cancer patients die more frequently than those that use homeopathy or aromatherapy. At least these don’t cause secondary cancers as chemo and radiation have shown with stellar records to do. Who ever came up with using something that causes cancer to cure cancer? Sounds like homeopathy to me!
Cancer centers have received billions of dollars to experiment with different combinations of the same old thing for 40 years with not much to show for it except granite buildings and huge salaries.
The oncologist uses as much hoping and wishing as the patient.
Walk for the cure, run for the cure, eat scones for the cure. Should be more like, “Run for the money”. Or better yet: Run for you life!
And what about the thousands of people who have been cured of cancer? I’m talking, of course, about those who have used conventional, or as I prefer to call it ‘real’ medicine. Those known to me whose lives have been extended by the very treatments you apaprently despise. I’ve never known anyone cured or even improved by one of the quack treatments offered by the ‘alternative’ brigade.
I fear that when you are directly affected yourself you may find your opinions changing.
Prof. EE, you should have included this, just for the sake of comparative completeness.
http://www.inquisitr.com/1485160/prominent-michigan-cancer-doctor-pleads-guilty-i-knew-that-it-was-medically-unnecessary/
Hello, GG,
This article is unbelievable! Smacks of Nazi experimentation. One has to re-read it several times for it to sink in that it actually happened. Of course, like most things like this, it is likely under-reported, which makes one really shudder. Thank you for posting it! Unfortunately, it produces a big “who cares” here.