Complementary therapies: Evaluating their effectiveness in cancer

Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB T2N 4N1 Canada.
Patient Education and Counseling (Impact Factor: 2.2). 11/1999; 38(2):101-8. DOI: 10.1016/S0738-3991(99)00057-9
Source: PubMed


The use of complementary therapies is common among cancer patients. However, a major concern is that very few of these therapies have been appropriately evaluated and, thus, little is known about their safety and efficacy. The gold standard for evaluating cancer treatments is the randomized controlled trial (RCT). However, there are several issues inherent to the nature and practice of complementary therapies that interfere with the straightforward use of RCTs. Alternative approaches are often highly individualized and attempt to respond to patients' needs. They are often holistic, taking into account many facets of a patient's life. Placebo effects and the role of the provider are frequently recognized as an important part of treatment. Outcomes of complementary therapies are often subjective, rather than being more objective outcomes, such as increased survival time. Although it is important to evaluate complementary therapies, it is mandatory that studies be sensitive to these issues and that existing research methods be adjusted and modified for this purpose.

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    • "However, there is growing acceptance that such a reductionist approach may not always be appropriate and that controlled study designs can be employed to test the effectiveness of therapy even when different participants in the treatment groups receive slightly different treatments (e.g. Hilsden and Verhoef, 1999; Richardson, 2000). This is particularly important in the study of behavioural optometry approaches because practitioners appear to place particular emphasis upon designing patient-specific approaches to treatment rather than applying uniform management/treatment strategies for particular conditions (Paul Adler, personal communication). "
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    ABSTRACT: In 2000, the UK's College of Optometrists commissioned a report to critically evaluate the theory and practice of behavioural optometry. The report which followed Jennings (2000; Behavioural optometry--a critical review. Optom. Pract. 1: 67) concluded that there was a lack of controlled clinical trials to support behavioural management strategies. The purpose of this report was to evaluate the evidence in support of behavioural approaches as it stands in 2008. The available evidence was reviewed under 10 headings, selected because they represent patient groups/conditions that behavioural optometrists are treating, or because they represent approaches to treatment that have been advocated in the behavioural literature. The headings selected were: (1) vision therapy for accommodation/vergence disorders; (2) the underachieving child; (3) prisms for near binocular disorders and for producing postural change; (4) near point stress and low-plus prescriptions; (5) use of low-plus lenses at near to slow the progression of myopia; (6) therapy to reduce myopia; (7) behavioural approaches to the treatment of strabismus and amblyopia; (8) training central and peripheral awareness and syntonics; (9) sports vision therapy; (10) neurological disorders and neuro-rehabilitation after trauma/stroke. There is a continued paucity of controlled trials in the literature to support behavioural optometry approaches. Although there are areas where the available evidence is consistent with claims made by behavioural optometrists (most notably in relation to the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain disease/injury), a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated.
    Ophthalmic and Physiological Optics 02/2009; 29(1):4-25. DOI:10.1111/j.1475-1313.2008.00607.x · 2.18 Impact Factor
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    • "Estas intervenções são frequentemente referidas como complementares, dado serem utilizadas paralelamente às terapias habituais (Hilsden & Verhoef, 1999; Verhoef, Hilsden, & O'Beirne, 1999). Para os doentes que usam terapias complementares, tomar decisões no sentido de usarem estas terapias providencia uma oportunidade significativa de obter algum controlo sobre a sua doença, tratamento e bem-estar durante os tratamentos e recuperação do cancro (Truant & Bottorff, 1999; Verhoef, Hilsden, & O'Beirne, 1999). "

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    • "Vickers, including lack of funding and insufficient patient numbers for a study [40]. Hilsden and Verhoef explained that evidence pertaining to the effectiveness of CAM is vital in the decision making of government regarding whether it should be administered or not [41]. Clinical trials are needed to help evaluate and ascertain the benefits of CAM. "
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    ABSTRACT: The use of Complementary and Alternative Medicine (CAM) among cancer patients is widespread and appears to be increasing. However, it is not clear whether patients use CAM as an 'alternative' to standard oncology care or as an adjunct to the conventional treatment they receive. This study reviews the role of CAM therapies in the management of cancer, from the view of both patients and health professionals and it highlights issues relating to the efficacy of CAM used by cancer patients. Most patients use CAM to 'complement' the conventional therapies of radiotherapy, chemotherapy, hormone therapy and surgery. Health professionals in general have expressed positive views when CAM is used 'complementarily' and not as an 'Alternative'. Results so far published have shown that CAM can contribute to improving the quality of life of cancer patients and their general well-being.
    International Seminars in Surgical Oncology 02/2007; 4(1):10. DOI:10.1186/1477-7800-4-10
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