Complementary and Alternative Medicine (NIH NCCAM) defines five domains of CAM: Age, race, and ethnicity in the use of complementary and alternative medicines …
ONCOLOGY NURSING SOCIETY POSITION
The Use of Complementary, Alternative, and Integrative Therapies in Cancer Care
Complementary and alternative therapies are described best as those not presently considered an integral part of conventional medicine Complementary therapies are used in conjunction with conventional medicine, alternative therapies are used in place of conventional medicine, and integrative therapies combine mainstream medical therapies with complementary or alternative therapies for which some high-quality scientific evidence of safety and efficacy exists National Center for Complementary and Alternative Medicine [NCCAM], 2004 Approximately 72 million adults in the United States use complementary and alternative therapies Tindle, Davis, Phillips, Eisenberg, 2005, and more than 34 billion per year is spent out-of-pocket for these therapies Herman, Craig, Caspi, 2005 Many researchers are examining the efficacy and safety of complementary and alternative therapies The
National Institutes of Health established NCCAM to fund research in complementary and alternative medicine CAM and created the Office of Cancer Complementary and Alternative Therapies to coordinate and enhance the National Cancer Institutes CAM activities Complementary and alternative practices have been categorized broadly as mind-body interventions, manipulative and body-based methods, biologically based methods, energy therapies, and alternative medical systems NCCAM, 2004 However, the list of complementary and alternative practices will continue to evolve as new therapies are proven to be safe and effective, accepted as mainstream healthcare practices, and integrated into patient care The most frequently used CAM therapies include prayer, natural products, deep breathing, meditation, chiropractic, yoga, and massage Barnes, Powell-Griner, McFann, Nahin, 2004 Researchers have reported that 5083 of patients with cancer use CAM therapies Basch Ulbricht, 2004, and the most common
reason for using CAM is a strong belief in its efficacy Verhoef, Balneaves, Boon, Vroegindewey, 2005 However, 4077 of people who use CAM therapies do not disclose CAM use because of concerns that healthcare providers will react negatively, because of a belief that healthcare providers do not need to know that they are using CAM because they regard it as natural and safe to use, and finally, because healthcare providers do not ask about CAM use Robinson McGrail, 2004 Oncology nurses may be caring for patients without knowledge of concurrent CAM use Routine assessment of CAM use and close monitoring of patients using CAM therapies have the potential to enhance patient safety and promote integrative care Lee, 2004
It Is the Position of ONS That
Oncology nurses should expand their individual knowledge regarding complementary, alternative, and integrative therapies in oncology care Formal cancer care education programs in schools of nursing and continuing education offerings should
include information and access to complementary, alternative, and integrative therapies and promote integrated education with other health disciplines Oncology nurses should seek proper training and obtain necessary credentials if practicing complementary, alternative, and integrative therapies Oncology nurses should develop a working knowledge of cost, reimbursement, liability, ethical, and legal issues surrounding complementary,
alternative, and integrative therapies in oncology care Oncology nurses should evaluate their personal and professional beliefs regarding the use of complementary, alternative, and integrative practices and recognize how these values can affect the care of patients seeking or using these therapies Oncology nurses should assess patients for the use of therapies and provide evidence-based information and resources regarding therapies as well as information about verifying practitioners qualifications and credentials Oncology nurses should have an
awareness of the differences among terms applied to CAM and use the terms alternative, complementary, and Continued on next page
Continued from previous page integrative with consistency and in an appropriate context Oncology nurses should develop an awareness of CAM therapies that potentially can interfere with the outcome of other cancer treatments Oncology nurses should document patients use of and response to CAM therapies Oncology nurses should establish evidence-based practice in these areas by synthesizing present knowledge with regard to safety, efficacy, concurrent use with conventional therapy, and long-term use ONS and its affiliates promote funding and collaboration in the design of methodologically rigorous cancer CAM treatment and supportive care clinical trials to study the impact of complementary, alternative, and integrative therapies on cancer care outcomes
References
Barnes, PM, Powell-Griner, E, McFann, K, Nahin, RL 2004 Complementary and alternative
medicine use among adults: United States, 2002 Advance Data, 27, 119 Basch, E, Ulbricht, C 2004 Prevalence of CAM use among
US cancer patients: An update [Editorial] Journal of Cancer Integrative Medicine, 21, 1314 Herman, PM, Craig, BM, Caspi, O 2005 Is complementary and alternative CAM cost-effective? A systematic review BMC Complementary and Alternative Medicine, 2, 11 Lee, CO 2004 Clinical trials in cancer part II Biomedical, complementary, and alternative medicine: Significant issues Clinical Journal of Oncology Nursing, 8, 670674 National Center for Complementary and Alternative Medicine 2004 The use of complementary and alternative medicine in the United States Retrieved November 16, 2004, from http://nccamnihgov/news/camsurvey_fs1htm Robinson, A, McGrail, MR 2004 Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies Complementary Therapies in Medicine, 12, 9098 Tindle, HA, Davis, RB, Phillips, RS, Eisenberg, DM 2005 Trends in use
of complementary and alternative medicine by US adults: 19972002 Alternative Therapies in Health and Medicine, 11, 4249 Verhoef, MJ, Balneaves, LG, Boon, HS, Vroegindewey, A 2005 Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: A systematic review Integrative Cancer Therapies, 4, 274286
Approved by the ONS Board of Directors 04/00; revised 06/02, 10/04, 03/06
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