Complementary and Alternative Medicine: What Should We Tell Our Patients?
May 7, 2013
The American College of Chest Physicians released the Diagnosis and Management of Lung Cancer, 3rd ed: ACCP Evidence-Based Clinical Practice Guidelines on May 7, 2013. The guidelines represent the culmination of a multiyear rigorous process involving over 100 multidisciplinary experts in the fields of pulmonology, critical care, thoracic surgery, medical and radiation oncology, pathology, integrative medicine, primary care, health-care research, guidelines methodology, and epidemiology. The ACCP guidelines summarize the state of the art in lung cancer in 24 chapters and 278 recommendations, covering the entire scope of the field. We have invited the LCIII chapter editors to highlight the advancements, points of interest, and general wisdom around their area of expertise.
Our first blog is from Gary Deng, MD, PhD, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, and chapter editor of the Complementary Therapies and Integrative Medicine in Lung Cancer chapter.
Soon after you laid out the treatment plan for a new lung cancer patient and before you were about to leave the room, the patient asked: “Doctor, what should I eat? I heard an asparagus diet is anti-cancer. How about vitamin B17? A friend of mine told me it can cure cancer. I also want to try acupuncture and Reiki. Are they going to help my treatment?”
One of the first things a sophisticated cancer patient would do after cancer diagnosis is to search the Internet for treatment options. Yet the resultant avalanche of information both informs and confuses the patient. Among the search results are “alternative cancer cures” touted to patients, and viral “tricks and tips” spread by well-meaning friends and relatives of the patient. Surveys have consistently shown that around 40% to 50% of cancer patients are interested in unconventional therapies, ranging from those shown to be safe and beneficial in clinical trials and can be used in cancer supportive care (complementary therapies) to those that are bogus or harmful (alternative therapies).
Because of the sheer numbers and diversity of those therapies, it is very hard to keep up with the latest research and offer patients proper advice. Simply stating “don’t use any of them” will not be very effective, because the very fact patients are exploring those therapies indicates that there is a deep-seated need that is not met by conventional medicine, be it the lack of effective treatment options, the desire for patient empowerment and activism, or beliefs that “anything natural is good.” They are more likely to continue using those therapies, just not letting you know.
A more effective approach is to find out the underlying psychological current, address that, and offer patients evidence-based yet compassionate advice, taking into consideration the patient’s values and priorities in cancer treatment. An effective discussion requires strong communication skills and knowledge on the complementary therapies and the current state of science of research findings. In the chapter “Complementary Therapies and Integrative Medicine in Lung Cancer” in the 3rd edition of the ACCP Lung Cancer Evidence-Based Clinical Practice Guidelines, the authors have systematically reviewed clinical trial data and summarized them into recommendations, after weighing the quality of the evidence and the burdens and risks to patients.
These guidelines can be used as tools to address patient’s questions, such as those at the beginning of this article. Armed with this information, a discussion of complementary and alternative medicine does not have to be a frustrating or disconcerting experience for either patient or physician. Instead, it can be an opportunity for the physician to show his/her humanity and compassion to what the patients feel important to them, strengthening the physician-patient bond and improving the quality of the care the patients are receiving.
To learn more about, and to review the guidelines in their entirety, visit our Lung Cancer III page. Join in the conversation about the new guidelines on social media. Comment on the ACCP Facebook wall, follow the ACCP on Twitter, and tweet with the hashtag #LCIII.
Dr. Deng is an Associate Member and Attending Physician at Memorial Sloan-Kettering Cancer Center in New York. His clinical expertise is in cancer supportive care and integrative medicine. He is a principal investigator of NIH funded research projects on acupuncture and botanical agents, and a lead author of review articles, textbook chapters and clinical practice guidelines in integrative medicine. Dr. Deng has taken a leadership role in this emerging and evolving field. He heads the physician training program in the Integrative Medicine Service and served as president of the Society for Integrative Oncology.