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 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] Massage 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 are broad ranging and diverse and 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) or used synonymously within the literature.

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] This has recently been found with traditional indigenous medicine, with practitioner attitudes greatly influencing disclosure of use. [11] 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 [12] 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. [13] Most commonly researched are massage, acupuncture/acupressure, meditation/relaxation, aromatherapy, and art or music therapy. [13]

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] In people with cancer, massage may lead to short-term improvements in pain symptoms [5,9,10] and mood [5,10] and acupuncture/acupressure may lead to improvements in chemotherapy induced nausea and vomiting. [14] Music therapy, which has become widely accepted into the health care system, [15] has shown benefits for agitation, behaviour modification and anxiety in older people. [16] Qigong, mindfulness, yoga, sensory therapy, animal-assisted therapy, art therapy, Tai Chi, aromatherapy, herbal medications, including cannabinoid products, and Traditional Chinese Medicine (TCM) lack strong evidence to support their effective use in cancer care, dementia care, aged care and palliative care. Safety and adverse effects have not been established for all CM.

Quality Statement

The systematic reviews were of acceptable [6,8,10,11,15,16] 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 09 July 2021
 

  • 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]. 2018 [updated 2018 Jul; cited 2020 Jul 7].
  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. Therapeutic Guidelines Limited. 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. Gall A, Leske S, Adams J, Matthews V, Anderson K, Lawler S, Garvey G. Traditional and Complementary Medicine Use Among Indigenous Cancer Patients in Australia, Canada, New Zealand, and the United States: A Systematic Review. Integr Cancer Ther. 2018 Sep;17(3):568-581. doi: 10.1177/1534735418775821. Epub 2018 May 21.
  12. Therapeutic Goods Administration (TGA). Australian regulatory guidelines for complementary medicines (ARGCM) Version 6.0 [Internet]. 2016 [cited 2017 Oct 25].
  13. CareSearch Palliative Care Knowledge Network. Complementary Therapies [Internet]. Adelaide: CareSearch; 2019 [updated 2019 Nov 8 18; cited 2021 Jul 9].
  14. Watson MS, Ward S, Vallath N, Wells J, Campbell R, editors. Oxford handbook of palliative care. 2nd ed. New York: Oxford University Press; 2019.
  15. Gao Y, Wei Y, Yang W, Jiang L, Li X, Ding J, Ding G. The Effectiveness of Music Therapy for Terminally Ill Patients: A Meta-Analysis and Systematic Review. J Pain Symptom Manage. 2019 Feb;57(2):319-329. doi: 10.1016/j.jpainsymman.2018.10.504. Epub 2018 Oct 30.
  16. Tsoi KKF, Chan JYC, Ng YM, Lee MMY, Kwok TCY, Wong SYS. Receptive Music Therapy Is More Effective than Interactive Music Therapy to Relieve Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2018 Jul;19(7):568-576.e3. doi: 10.1016/j.jamda.2017.12.009. Epub 2018 Feb 1.

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])