Complementary Medicine
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Complementary Medicine (CM)

Key Messages

  • Complementary Medicine (CM) is a broad term used to describe a wide range of health care medicines and therapies (forms of treatment that do not involve medicines) that are presently considered as separate to conventional medicine. [1-5] These can be used together with or in place of conventional medicine. [2,5]
  • If an adult has used CM, there is an increased likelihood of this use continuing in older age or in the treatment of cancer. [4]
  • At least half of all patients with cancer use some form of CM. [4,6] The use of CM in Australia is considerable [1,2] and increasing. [1] Not all people discuss their use of CM with their doctor or health professional. [2,4]
  • There is a substantial gap between the use of complementary medicine and the evidence to support that use [1,4,6] and the potential for interactions of CM with conventional treatments is a concern. [6]
  • Clinicians need to ask people in their care whether they are using any complementary or alternative medicine, particularly prescribed or ‘over the counter’ (OTC) herbal and vitamin supplements, to be aware of the effectiveness, benefits, risks and safety of treatment choices. [1,2,4,6,7]
  • Massage has emerged as a practical supplement to individualised care of the older person. [8] Acupuncture, massage and relaxation techniques may lead to short-term improvements in pain symptoms [5,9,10] and mood [5,10] in cancer patients.

Background

Often the term ‘complementary medicine’ refers to both complementary medicines and therapies that are presently considered as separate to conventional medicine. [1-5] Complementary medicines (CMs) include herbal medicines, some vitamin and mineral supplements, other nutritional supplements, homeopathic formulations, aromatherapy, and traditional medicines such as ayurvedic medicines and traditional Chinese medicines. [1,2,4] Complementary therapies include acupuncture, chiropractic, osteopathy, naturopathy, massage and meditation. [1,4] CM products and therapies are called ‘complementary medicine’ when used together with conventional medicine, or ‘alternative medicine’ when used as an alternative to conventional medicine. [2] These may be brought together under the title Complementary and Alternative Medicine (CAM).

Evidence Summary

At least half of all patients with cancer use some form of CM. [4,6] If an adult has used CM, there is an increased likelihood of this use continuing in older age or in the treatment of cancer. [4] It is estimated that more than two-thirds of the Australian population use CM, and the national annual ‘out of pocket’ expenditure on CM is estimated to be approximately $4 billion. [2] The boundaries between CM and conventional medicine are not always clear, with some specific CM practices becoming more widely used over time. [2] Cultural and traditional use or personal beliefs may influence a person’s understanding and use of CM. [2,6]

People may choose to use CM because they believe that CM products and therapies are ‘natural’ and ‘safer’ than conventional medicine or through dissatisfaction with conventional medicine. [2,4,6] People with advanced cancer can see CM as useful in managing distress or unmet physical and/or psychological needs. [4]

Not all people will discuss their use of CM with doctors or health professionals. [2,4] This is often because the clinician has not asked them about it but it may also be their unease in raising or discussing the topic. [2,4] An important consequence of this is that the evidence supporting the effectiveness of CM and the potential risks of the use of CM are not discussed. [2,4]

Doctors, nurse practitioners, pharmacists and allied health professionals need to ask the question ‘Are you using any complementary or alternative medicine?’ and even ask specific questions regarding herbal and vitamin supplements as these can be contraindicated with some medications. [1,2,4,6,7] Health care professionals can facilitate shared decision-making that is compatible with the individual’s values and goals regardless of stage of illness. [1,2,4]

In Australia, the guidelines for the use of complementary medicines [11] are restricted to medicines and not therapies and are not specific to older people or to people receiving palliative care. A number of specialist palliative care services do offer a range of complementary therapies for their patients and for their family and carers. [12] Most commonly, on offer are massage, acupuncture/acupressure, meditation/relaxation, aromatherapy, and art or music therapy. [12]

While tactile sensory perception diminishes with ageing, the need for the older person to be touched remains important to their health. [8] Massage emerges as a practical supplement to individualised care of the older person. [8] Acupuncture, massage and relaxation techniques may lead to short-term improvements in pain symptoms [5,9,10] and mood [5,10] in cancer patients. Qigong, mindfulness, relaxation, yoga, music therapy, sensory, pet therapy, art therapy, Tai Chi, aromatherapy, herbal supplements, Traditional Chinese Medicine (TCM) lack strong evidence to support their safe and effective use in cancer care, dementia care, aged care and palliative care.

Quality Statement

The systematic reviews were of acceptable [6,8,10] or high quality. [4,9] There is a paucity of reviews relevant to the both the aged and palliative care sectors. Most RCTs from the systematic reviews are of low quality due to small sample size, poor methodological quality, and low uniformity that hampers comparability.

 

Updated 04 September 2019

  • References

  • About PubMed Search

  1. Australian Medical Association Limited (AMA). AMA Position Statement: Complementary Medicine - 2018. Canberra: AMA: 2018.
  2. National Health and Medical Research Council (NHMRC). Talking with your patients about Complementary Medicine - a Resource for Clinicians. Canberra: NHMRC; 2014.
  3. National Health and Medical Research Council (NHMRC). Complementary medicines [Internet]. 2018 [cited 2018 Oct 5].
  4. Truant TL, Porcino AJ, Ross BC, Wong ME, Hilario CT. Complementary and alternative medicine (CAM) use in advanced cancer: a systematic review. J Support Oncol. 2013 Sep;11(3):105-13.
  5. National Center for Complementary and Integrative Health (NCCIH). Complementary, Alternative, or Integrative Health: What’s In a Name? [Internet]. 2017 [updated 2016 Jun; cited 2017 Oct 25].
  6. Weeks L, Balneaves LG, Paterson C, Verhoef M. Decision-making about complementary and alternative medicine by cancer patients: integrative literature review. Open Med. 2014 Apr 15;8(2):e54-66. eCollection 2014.
  7. Palliative care Expert Group. Therapeutic guidelines: palliative care. Version 4. Melbourne: Therapeutic Guidelines Limited; 2016.
  8. McFeeters S, Pront L, Cuthbertson L, King L. Massage, a complementary therapy effectively promoting the health and well-being of older people in residential care settings: a review of the literature. Int J Older People Nurs. 2016 Dec;11(4):266-283. doi: 10.1111/opn.12115. Epub 2016 Feb 15.
  9. Choi TY, Lee MS, Kim TH, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. 2012 Jun;20(6):1147-58. doi: 10.1007/s00520-012-1432-9. Epub 2012 Mar 25.
  10. Falkensteiner M, Mantovan F, Muller I, Them C. The use of massage therapy for reducing pain, anxiety, and depression in oncological palliative care patients: a narrative review of the literature. ISRN Nurs. 2011;2011:929868. doi: 10.5402/2011/929868. Epub 2011 Aug 23.
  11. Therapeutic Goods Administration (TGA). Australian regulatory guidelines for complementary medicines (ARGCM) Version 6.0 [Internet]. 2016 [cited 2017 Oct 25].
  12. CareSearch Palliative Care Knowledge Network. Complementary Therapies [Internet]. 2017 [updated 2017 Jan 18; cited 2017 Oct 25].

Complementary Therapies (Definition)

Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some (PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment. (MESH)

Searches

Complementary Therapies

(Complementary Therapies[Mesh] OR complementary[tiab] OR alternative therap*[tiab] OR alternative medicine*[tiab] OR traditional medicine*[tiab] OR acupuncture[tiab] OR holistic[tiab] OR massage[tiab] OR relaxation[tiab] OR music[tiab] OR yoga[tiab] OR meditation[tiab] OR pets[tiab] OR animal assisted therapy[mesh] OR art[tiab] OR aromatherapy*[tiab] OR ayurvedic[tiab] OR tai[tiab] OR laugher[tiab])