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Complementary and alternative therap
Published on Cancer Australia
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Complementary and alternative therapies
First published:
April 2004
Revised & updated:
April 2010
Complementary and alternative therapies
1. Complementary and alternative therapies are commonly used by cancer patients.
2. There is evidence to support the effectiveness of some complementary therapies and for
such therapies, clinicians should discuss their potential benefits and use alongside
conventional therapies. Some therapies may interfere with conventional treatments.
3. Most alternate therapies have not been assessed for efficacy or safety. Some have been
studied and found to be harmful or ineffective.
4. Clinicians should encourage discussion with their patients about complementary and
alternative therapies in an open, evidence-based and patient-centred manner. The issues of
effectiveness, safety and cost should be explored with all patients using such therapies.
5. NBOCC* supports ongoing scientific evaluation of complementary and alternative therapies.
Evidence
Complementary and alternative therapies
Although there is some looseness in usage of the terms, complementary therapies refer to those
therapies that do not replace or preclude conventional medical therapies, whereas alternative
therapies are treatment options outside the orthodox range, that may be used in place
of conventional treatments.
Complementary therapies are a range of approaches to care aimed at enhancing quality of life
and improving wellbeing, that are generally used in conjunction with conventional medical
treatments such as surgery, radiotherapy, chemotherapy, hormonal therapies or targeted therapies.
Complementary therapies may include acupuncture, relaxation therapy and meditation, gentle
exercise, guided imagery, music or art therapy, massage, aromatherapy, some dietary therapies and
support group programs.
Some complementary therapies have been subject to scientific evaluation and shown to be effective
(Level I evidence).1 There is evidence for the effectiveness of cognitive and behavioural techniques,
such as relaxation and guided imagery in reducing symptoms and anxiety,2, 3 and for cognitive
behavioural techniques and therapies such as prayer and meditation in the management of pain.2,
4
However, some therapies that might be considered ‘complementary’ can in some circumstances be
harmful. For example, some dietary supplements, including megadoses of vitamins and minerals
may interfere with chemotherapy.5
Alternative therapies are treatments which may be offered as an alternative to conventional
treatments. They are outside the orthodox range of surgery, radiotherapy, chemotherapy, hormonal
or targeted therapies. Approaches that may be offered as alternative therapies range from
visualisation to diet and prayer, and products such as vitamin supplements, herbal and homeopathic
medicines.
There is little evidence that alternative therapies are effective. Most have not been assessed for
efficacy in randomised clinical trials, though some have been examined and found to be
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ineffective.6 Ongoing studies evaluating complementary and alternative therapies are being
conducted by the National Center for Complementary and Integrative Health.
There are safety issues to be considered for the use of therapies that alter diet or involve the
consumption of substances, since many have not been assessed for safety. The content of some
substances is uncontrolled and may be variable. They may be adulterated with other active
compounds, or can be intrinsically toxic.6 Therapies considered potentially dangerous for women
with advanced breast cancer include calcium supplementation for bone disease, iron and vitamin C
supplementation by women receiving blood transfusions, diets that may be nutritionally inadequate
and the frequent use of enemas.6 In addition, there are potentially negative psychological and
financial impacts related to use of alternative therapies.
Use of complementary and alternative therapies
A recent survey of Australian women with breast cancer found that 87.5% had used complementary
therapies, with many using 4 or more therapies.7 The most commonly used were vitamin
supplements (54%), support groups (50%), massage (41%) and meditation (39%). Other studies
overseas have reported that 63% - 83% of breast cancer patients use at least one type of
complementary or alternative therapy.8 The use of complementary and alternative therapies by
adult cancer patients has been reported to be 7 - 64%9 and 22% in Australia.10 Approximately 50% of
ovarian cancer patients have reported using complementary or alternative therapies in some small
studies.11
Some patients use complementary and alternative therapies to gain a feeling of control over the
treatment of their disease. Reasons given include the need for a new source of hope, preference for
natural therapy and achieving a sense of greater personal involvement.10 One large study has found
there is a significant association between the use of complementary and alternative therapies by
cancer patients and needs unmet by conventional medicine, helplessness and lower scores on
emotional and social functioning scales.12 Other reasons reported by women with breast cancer in
Australia and overseas for using complementary and alternative therapies, include improving
physical and emotional wellbeing and quality of life, boosting the immune system and seeking to
reduce side effects.7, 8
Discussing the use of complementary and alternative therapies
It has been reported in an Australian study that 40% of patients did not discuss alternative medicine
with their clinician.10 It is to the advantage of all concerned, if patients are able to discuss
complementary and alternative therapies openly, secure in the knowledge that they will continue to
receive support and understanding from their treatment team.
For many women, feeling they can assume some control of the treatment of their disease is
psychologically empowering.
The issues of effectiveness, safety and cost need to be explored with all patients who use
complementary and alternative therapies. It is important for the clinician to be aware of all
medication the patient is taking, to avoid adverse interactions with drugs. Guidelines for clinicians to
assist in discussing complementary and alternative therapies have been developed.13
References
1. National Breast Cancer Centre** and National Cancer Control Initiative. Clinical practice
guidelines for the psychosocial care of adults with cancer. Camperdown, NSW: National
Breast Cancer Centre** 2003
2. Devine EC, Westlake SK. The effects of psychoeducational care provided to adults with
cancer: meta-analysis of 116 studies. Oncol Nurs Forum 1995;22(9):1369-81.
3. Meyer TJ, Mark MM. Effects of psychosocial interventions with adult cancer patients: a metaPage 2 of 3
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analysis of randomized experiments. Health Psychol 1995;14(2):101-8.
4. Kwekkeboom KL. Pain management strategies used by patients with breast and gynecologic
cancer with postoperative pain. Cancer Nurs 2001;24(5):378-86.
5. Deng GE, Frenkel M, Cohen L, et al. Evidence-based clinical practice guidelines for integrative
oncology: complementary therapies and botanicals. J Soc Integr Oncol 2009;7(3):85-120.
6. National Breast Cancer Centre**. Clinical practice guidelines for the management of
advanced breast cancer. Canberra: Commonwealth of Australia 2001
7. Kremser T, Evans A, Moore A, et al. Use of complementary therapies by Australian women
with breast cancer. Breast 2008;17(4):387-94.
8. DiGianni LM, Garber JE, Winer EP. Complementary and alternative medicine use among
women with breast cancer. J Clin Oncol 2002;20(18 Suppl):34S-8S.
9. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a
systematic review. Cancer 1998;83(4):777-82.
10. Begbie SD, Kerestes ZL, Bell DR. Patterns of alternative medicine use by cancer patients.
Med J Aust 1996;165(10):545-8.
11. The Australian Cancer Network and National Breast Cancer Centre**. Clinical practice
guidelines for the management of women with epithelial ovarian cancer. Camperdown, NSW:
National Breast Cancer Centre** 2004
12. Paltiel O, Avitzour M, Peretz T, et al. Determinants of the use of complementary therapies by
patients with cancer. J Clin Oncol 2001;19(9):2439-48.
13. Schofield P, Diggens J, Charleson C, Marigliani R, Jefford M. Effectively discussing
complementary and alternative medicine in a conventional oncology setting: communication
recommendations for clinicians. Patient Educ Couns 2010;79(2):143-51
** In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer
Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). On 30 June
2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia,
to provide leadership in cancer control and improve outcomes for Australians affected by cancer.
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