I have had an incredible time reflecting in modern medical practice in the light of the first week’s research. As a research project, I know how much time I have ut into this so far, I ask myself, as I start the second week to investigate where and how oncologists may find information on CAM, I wonder why would they want to? – Motivation? They are too hard-worked already.
I went further and discovered that nearly 30% of all deaths in NZ are due to cancer!!
51 new cases diagnosed a day and 22 deaths.
No doubt as an oncologist I would be well aware that I, or one of my family, would be likely to go through the cancer process in my lifetime, and I may wish to learn what I could do to help myself. I may not see the ‘either/or’ CAM or WOM debate as being important, so much as whatever works.
In reading the Crystal paper, the use of the royal ‘we’ written from the position of power (conventional, orthodox, WOM) sets the tone in this entire debate.
Saying ‘we’ need to know more – at least shows that there is an understanding of the possibilities that there may be more out there. Placing ‘CAM’ in a box I feel needs further discussion and I will come to that in later posts.
Starting from a paradigm of nature healing, and the body being in charge (vitalism, and wholism) we learnt about in lectures, and is written in many of Prof Ian Coulter’s works, the practitioner and the person with cancer may realise that profound life change may be needed.
Will I, as the oncologist, be looking into the CAM as a foreigner?
As such, can I even grasp the paradigm shift needed?
‘This fundamental apriori difference between CAM and biomedicine leads to a different logic for approaches to treatment. In CAM, the focus is on treating the patient whose body then will initiate the healing. Where in biomedicine the intent of the provider is to cure the patient, in CAM the intent is to assist the patient to heal themselves. In this approach, diseases are symptoms of a more fundamental underlying cause.
Disease here means dis-ease or lack of ease in the body not pathology’. (Coulter and Khorsan 2012).
If not, how could I, as an oncologist, begin to research this to make sense of what may help a patient?
Standard research is not showing what the patients themselves seem to have grasped – there is considerable help out there that is not reflected in research findings.
There is not a homogeneous bunch called ‘oncologists’ – but three sub groups of oncologists. I suspect the ones most interested in CAM may be the medical oncologists, as it would be their sub-speciality that would be mostly affected by the ingestion of different substances than expected.
Anything that affected the efficacy or the toxicity of the chemo, or made it less or more stable would reflect massively in their work. CAM may also allow the patient to continue on their orthodox treatment.
1) – As an oncologist I may wish to prepare the patient as well as possible for the invasive therapy. Anything to calm their fears and anxieties – I may note that Reiki is offered at nearly 800 hospitals in the USA. What has been called CAM (Reiki (and prayer) may be helpful – at least not harmful.
Without understanding the process of how Reiki became integrated into the hospital setting, I would imagine popular demand due to possibly perceived benefit – possibly the patient’s demand created the change. Healing intention could surely not hurt the chemo process?
It may muddy the waters in understanding medical research into the protocol changes we may have made. How would we know what was due to what? (Does the patient care?) The perceived negative reaction from the authority figure in the patient’s battle for life, may be why the patient is so reticent to tell the specialist – as they wish to improve their chances as they see it.
This brings on line all the worries that oncologists have regarding potential damage to the patient which is written in the negative, not what potential gain that may be had in mixing any form of CAM and WOM.
2) – I may wish to assist the patients who are having a hard time with the side effects of the therapy chosen for them.
Whether extreme nausea, or inability to keep the treatments going because of potential liver failure and organ system breakdown, due to the toxicity of the chemo – I may have at least anecdotally have noticed that some patients using some CAM were better able to handle the treatment and suggest they try the same.
I may be heartened that in searching for possible harm in the use of anti-emetics and acupuncture, none were noted in the few trials I found and that other useful markers were enhanced.
3) – After chemo or other invasive therapy – what then?
‘A Canadian survey of more than 900 cancer patients is quoted as demonstrated that 94% experienced disease-related symptoms such as fatigue and anxiety that were not addressed by their conventional treatment’. http://theoncologist.alphamedpress.org/content/11/7/732.full
This is before the seemingly inevitable – return of the cancer.
- Does the patient await this in fear, or do they live their lives without a care?
- Do they change what created their woes?
Post treatment they are not likely to be healthy. Absence of the cancer hopefully – but likely to be remarkably unwell from the toxic treatments.
- Can CAM help when we as the oncologists have finished with them?
- Will the use of CAM in some form enhance a return to wellness that they may not have enjoyed before?
- How to evaluate this?
- What of quality of life post treatment?
4) – For those who can have no more orthodox treatment, who are considered terminal or in ‘remission’, and as good as they will ever be – what help may CAM offer – in quality of life enhancers, meditation and readiness for palliative care?
Practitioner burnout – how do oncologists keep going? From forming relationships (most bound to be very temporary) and being chatty with patients, especially getting to know them as people would create more stress on top of the workload, as people would be forever disappearing – in spite of all my best efforts.
Possibly I may as an oncologist be rocked to the core with the findings from the meta analysis http://www.curenaturalicancro.com/oncologists-criticize-chemotherapy.html 2.3% improvement in outcome in Australia after 5 years, 2.1% in USA.
In summary, the authors state:
“The introduction of cytotoxic chemotherapy for solid tumors and the establishment of the sub-specialty of medical oncology have been accepted as an advance in cancer management. However, despite the early claims of chemotherapy as the panacea for curing all cancers, the impact of cytotoxic chemotherapy is limited to small subgroups of patients and mostly occurs in the less common malignancies.”
As an oncologist I may be thinking differently as I am facing burnout.
I may even have availed myself for some acupuncture for the tension headaches and insomnia, and be amazed at how much better I felt afterwards.
Given the lack of reputable standardised trials in medical research bases, and the mismatch there with the beliefs and convictions, and downright unusual recoveries of some of my patients, I may do what the average person does, and trawl the Internet.
If I (as an oncologist) start thinking differently – outside the disease model and ask a question – ‘What causes cancer?’ If we stop this process – rather than just being reactive with the result, then surely the end point which most would hope for – quality and length of life restored – would be assured.
Possibility better outcomes than as present with orthodox disease centred therapy alone and no health restoration?
Wikipaedia says of cancer causation –
Cancers are primarily an environmental disease with 90-95% of cases attributed to environmental factors and 5-10% due to genetics.Environmental, as used by cancer researchers, means any cause that is not genetic, not merely pollution. Common environmental factors that contribute to cancer death include tobacco (25-30%), diet and obesity (30-35%), infections (15-20%), radiation (both ionizing and non-ionizing, up to 10%), stress, lack of physical activity, and environmental pollutants.
Besides the fact of introducing vastly more toxins through the therapeutic care in WOM, what can be done to remove what is creating the body producing cancer if this is correct? All of these may be addressed to some length with CAM.
Would I as an oncologist be interested in my charges living well after therapy? Of course. Investigation into lifestyle and other CAM would be outside my scope of practice – if I recognized my professional boundaries.
Looking to diet – as oncologists do not (outside their scope of practice) – and some CAM practitioners as naturopaths do – the role of dietary and life style changes for longevity and also prevention may cross my mind.
All of these fall into the life education category, which is not a surgical specialist’s field. There is much to know and the time-poor oncologist may be hard pressed to understand what the patient may have had, with their vested interest and all the past few days/weeks/months to ponder and evaluate for themselves.
How best to evaluate what the patient may have found and want to discuss?
Perhaps honesty is the best policy – it is outside my field of expertise (as an oncologist) and those most qualified are those who enhance health, not treat diseases?
- Chrystal, K., Allan, S., Forgeson, G., & Isaacs, R. (2003). The use of complementary/alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. The New Zealand medical journal, 116(1168), U296. URL: http://www.ncbi.nlm.nih.gov/pubmed/12601420
- Ian D. Coulter, and Raheleh Khorsan, (2012) in Outcomes Measurement in the Human Services: Cross-Cutting Issues and Methods, Second Edition, Washington D.C.: National Association of Social Workers Press, 2012, ed Jennifer Magnabosco and Ron Manderscheid (Eds)