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 05 October 2018