CAM and Cancer Care: An Overview

Jeri O’Dowd RN BSN CTM RYT

Overview of Project: Results of Nursing CAM Knowledge and Attitude Survey

Goal of Presentation: Provide an overview of CAM Relax / Renew with Yogic breath and essential oils

ACHS Capstone Project

List common terms used when defining CAM Discuss the history of CAM Discuss use of CAM among cancer patients Identify those most likely to use CAM Describe advantages / disadvantages of CAM Discuss how assessment skills can be improved when identifying the use of CAM in patients Identify reliable resources

Objectives:

“Complementary” generally refers to using a non-mainstream approach together with conventional medicine. “Alternative” refers to using a non-mainstream approach in place of conventional medicine. (Not common) Is the term “Complementary AND Alternative Medicine” a problem?

What is CAM?

“Integrative Medicine” combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. “Integrative Oncology”

What is CAM?

•  Much of what is now considered CAM was once mainstream. –  Herbal preparations –  Energy Therapy –  Ayurvedic Medicine (India) / Traditional Chinese Medicine

•  Evolution of Western Medicine –  Non-holistic approach / linear thinking –  Antibiotics / technological advancements –  Evidence based treatments

•  Renewed interest in CAM and increased usage

CAM Past to Present

•  Why the increased interest and usage, specifically among cancer patients?

–  Decreased faith in traditional medicine –  To Improve QOL (anxiety, pain, nausea, etc.) –  Desire for control of own care /autonomy –  Belief that CAM modalities are safe / nontoxic –  Accessibility (lower cost, no Rx) –  Vulnerability

CAM Past to Present

CAM: Advantages / Disadvantages •  Advantages

–  Access

–  Cost

–  Safety / Efficacy

•  Disadvantage –  Stigma

–  Insurance

–  Safety / Efficacy

–  Regulations / Quality Control /Certifications

•  CAM modalities are classified by category

– NCCAM

–  OCCAM

What is Considered CAM?

“The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government’s lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” http://nccam.nih.gov

The National Center of Complementary and Alternative

Medicine

NCCAM’s 2 Main Categories •  Natural

Products (Biologically based):

–  Herbs –  Vitamins /

Minerals –  Probiotics

•  Mind Body Practices: –  Acupuncture –  Massage Therapy –  Hypnotherapy –  Spinal Manipulation –  Tai Chi –  Qi Gong –  *Healing Touch –  *Meditation –  *Relaxation Techniques –  **YOGA

•  Alternative Medical Systems:

–  Ayurvedic Medicine

–  Traditional Chinese Medicine

–  Homeopathic Medicine

–  Naturopathic Medicine

NCCAM’s Additional Category:

The Office of Cancer Complementary and Alternative Medicine (OCCAM) is an office of the National Cancer Institute (NCI) in the Division of Cancer Treatment and Diagnosis. OCCAM is responsible for NCI’s research agenda in complementary and alternative medicine (CAM) as it relates to cancer prevention, diagnosis, treatment, and symptom management. http://cam.cancer.gov

Office of Cancer Complementary and Alternative Medicine

Domain     Examples  

Alterna(ve  Medical  Systems   Ayurveda,  Tradi(onal  Chinese  Medicine,  Acupuncture,  Homeopathy,  Naturopathy,  Tibetan  Medicine  

Energy  Therapies   Qigong,  Reiki,  therapeu(c  touch  

Exercise  Therapy   Tai  Chi,  Hatha  Yoga,  Dance  Therapy  

Manipula(ve  and  Body  based  methods   Chiroprac(c,  massage,  reflexology  

Mind-­‐Body  Interven(ons   Medita(on,  Art  therapy,  imagery,  relaxa(on  techniques,  aromatherapy,  pet  therapy  

Nutri(onal  Therapeu(cs   Macrobio(cs,  veganism,  Vitamins,  an(oxidants  

Pharmacologic  /  biologic   Mistletoe,  high  dose  Vitamin  C,  products  from  honey  bees  

Complex  natural  products  (subcategory  of  above)   Botanicals,  herbs,  herbal  extracts,  tea  polyphenols,  shark  car(lage  

Spiritual  Therapies   Prayer,  Spiritual  Healing  

OCCAM’s Categories

•  Current estimates of use vary widely (20-80%) –  Why the wide range?

•  Definition of CAM ? •  Is prayer CAM? •  Fear / Shame

•  Most frequently reported CAM modalities in Oncology –  Spiritual Healing / Prayer –  Herbal* and Vitamin Supplements

CAM Use in Oncology

•  Who is most likely to use a CAM modality? – Younger age – Female; particularly African American

females – Higher educations – Higher income – Breast Cancer

CAM Use in Oncology

Nurses need the knowledge to do a health assessment that includes questioning about CAM, identifying potential or real drug interactions related to CAM use, and informing physicians and other healthcare providers of the potential for dangerous consequences as a result of CAM use. (Cuellar, Cahill, Ford & Aycock 2003)

The Role of the Oncology Nurse

•  Nurses need the knowledge to do a health assessment that includes questioning about CAM.......

–  Intake forms and verbal assessments should include an integrative assessment •  Conduct a comprehensive medication summary •  All previous and current CAM therapies (with examples) •  Any anticipated CAM use (with examples) •  Desire for CAM information •  Nutrition •  Physical Activity / Exercise •  Stress management •  Spirituality

The Role of the Oncology Nurse

……nurses need the knowledge to identify potential or real drug interactions related to CAM use…

Example: Of the top 20 herbal supplements sold in the United States, 7 have potentially relevant known or suspected herb-chemotherapy reactions:

1.  Garlic 2.  Echinacea 3.  Gingko 4.  Soy 5.  Ginseng 6.  St. John’s Wort 7.  Grape Seed

The Role of the Oncology Nurse

Where to go for Guidance? Agency   Website  

American  Cancer  Society   hPp://www.cancer.org  

OCCAM   hPp://cam.cancer.gov/about_us.html  

NCCAM   hPp://nccam.nih.gov/  

Society  for  Integra(ve  Oncology   hPp://www.integra(veonc.org/index.php/docguide  

ONS   hPps://www.ons.org  

American  Holis(c  Nurses  Assoc.   hPp://www.ahna.org/  

MD  Anderson  Cancer  Center:  Integra(ve  Medicine  Department  

hPp://www.mdanderson.org    

Arizona  Ctr.  for  Integra(ve  Medicine  

hPp://integra(vemedicine.arizona.edu  

Duke  Integra(ve  Medicine   hPp://www.dukeintegra(vemedicine.org  

Memorial  Sloan  KePering  Cancer  Center  –  Integra(ve  medicine  

hPp://www.mskcc.org/cancer-­‐care/integra(ve-­‐medicine  

Natural  Medicines  Comprehensive  Database  

hPp://naturaldatabase.therapeu(cresearch.com  

•  Guidelines –  Society of Integrative Oncology’s Evidenced Based

clinical Practice Guidelines for Integrative Oncology •  http://www.integrativeonc.org/index.php/docguide

–  American Cancer Society’s Guidelines for Using Complementary and Alternative Methods •  http://www.cancer.org/treatment/treatmentsandsideeffects/

complementaryandalternativemedicine/complementaryandalternativemethodsandcancer/cam-and-cancer-toc

Where to go for Guidance

•  Position Statements –  Oncology Nursing Society: The Use of Complementary and Alternative

Therapies in Cancer Care: •  http://www2.ons.org/Publications/Positions/media/ons/docs/

positions/alternativetherapies.pdf

–  American Holistic Nurses Association: Position on the Role of Nurses in the Practice of Complementary and Alternative Medicine •  http://www.ahna.org/Resources/Publications/Position-Statements

–  North Carolina State Board Of Nursing: Complementary Therapies Position Statement for RN and LPN Practice •  http://www.ncbon.com/myfiles/downloads/position-statements-

decision-trees/complementary-therapies.pdf

Where to go for Guidance

Summary Questions Evaluation Form Energize with Breath of Fire and essential oils

Conclusion

•  AHNA. (2014). Position Statements. Retrieved from American Holistic Nurses Association: http://www.ahna.org/Resources/Publications/Position-Statements#P1

•  American Cancer Society. (2014). Complementary and Alternative Methods and Cancer. Retrieved from American Cancer Society: http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/complementaryandalternativemethodsandcancer/cam-and-cancer-toc

•  Cuellar, N. G., Cahill, B., Ford, J., & Aycock, T. (2003). The Development of an Educational Workshop on Complementary and Alternative Medicine: What Every Nurse Should Know. The Journal of Continuing Education in Nursing, 128-135.

•  Decker, G. M., & Lee, C. L. (2010). Handbook of Integrative Oncology Nursing: Evidence-Based Practice. United States of America: Oncology Nursing Society.

References

•  Fouladbakhsh, J., Stommel, M., Given, B. A., & Given, C. W. (2005). Predictors of Use of Complementary and Alternative Therapies Among Patients With Cancer. Oncology Nursing Forum, Vol 32, No 6.

•  National Cancer Institute. (2012, November 11). OCCAM: Categories of CAM Therapies. Retrieved from National Cancer Institute: http://cam.cancer.gov/health_categories.html

•  North Carolina Board of Nursing. (2009, November). Position Statements: Complementary Therapies. Retrieved from North Carolina Board of Nursing: http://www.ncbon.com/dcp/i/nursing-practice-position-statements-decision-trees

•  Oncology Nursing Society. (2009, March). Oncology Nursing Society: The Use of Complementary, Alternative, and Integrative Therapies in Cancer Care. Retrieved from Oncology Nursing Society: http://www2.ons.org/Publications/Positions/media/ons/docs/positions/alternativetherapies.pdf

•  Parker, P. A., Urbauer, D., Fisch, M. J., Fellman, B., Hough, H., Miller, J., . . . Cohen, L. (2013). A Multi-site, Community Oncology-Based Randomized trial of a Brief Educational Intervention to Increase Comunication Regarding Complementary and Alternative Medicine. Cancer, 3514-3522

References

•  Rausch, S. M., Winegardner, F., & Kruk, K. M. (2011). Complementary and Alternative Medicine: Use and Disclosure in Radiation Oncology community Practice. Supportive Care in Cancer, 19:521-529.

•  Rojas-Cooley, T. M., & Grant, M. (2006). Complementary and Alternative Medicine: Oncology Nurses' Experiences, Educational Interests, and Resources. Oncology Nursing Forum, Vol 33 No 3.

•  US Department of Health and Human Services. (2014). National Center of Complementary and Alternative Medicine. Retrieved from National Institute of Health: http://nccam.nih.gov/

•  Yates, J. S., Mustian, K. M., Morrow, G. R., Gillies, L. J., Padmanaban, D., Atkins, J. N., . . . Colman, L. K. (2005). Prevalence of Complementary and Alternative medicine use in cancer patients during treatment. Supportive Care in Cancer, 806-811.

•  Yong, C. (2013). Open Communication between Patients and Doctors about Complementary and Alternative Medicine Use: The Key to Avoiding Harmful Herb-Drug Interactions among Cancer patients. Alternative Integrative Medicine, 2:1.

References