CAM and cancer

The use of CAM by cancer patients is reported to be increasing. The reasons why cancer patients use CAM are not fully understood. Possible explanations are that cancer patients expect CAM to cure the disease, achieve a longer survival time and decrease the side-effects of cancer treatments. At the psychosocial level, patients are facing fears about death and they are searching for support and hope. The use of CAM can thus be seen as a coping strategy.

The challenge for oncologists is to give an objective and responsible answer to this type of demand. Discrediting CAM outright might cause patients to seek advice from unqualified healers. An informative dialogue should therefore be offered on all questions and needs of patients and their relatives. If unrealistic help is expected from CAM (e.g. a cancer cure) healthcare professionals should try to find a consensus with the patient on realistic treatment goals. The importance of a good patient–doctor relationship must be underlined. Most cancer patients are confronted with long-term treatment, medical follow-up or rehabilitation. The side-effects of treatment and emotional strain may undermine continued compliance. It is an important challenge to promote greater patient–physician communication. There is strong evidence that the quality of the patient–physician communication affects patient adherence to the treatment plan recommended by the physician.

Healthcare professionals should prevent CAM being used as an alternative to conventional therapies. A need exists to provide reliable evidence-based information for healthcare professionals in order to help them to inform their cancer patients. Misinformation always has the potential to harm patients. It can raise the wrong expectations regarding treatment options or jeopardise trust in their oncologist. In turn this could endanger compliance and undermine treatment effectiveness.

Rumours, the media and the Internet spread both accurate and inaccurate information at accelerating rates. Cancer patients and the public are flooded with information of highly variable quality about CAM. It is critical that both patients and physicians have access to reliable evidence-based information. At the European level, scattered resources and a redundance of activities are noticeable. A European network is therefore necessary.

In 2002, the European Commission, within the framework of the Quality of Life and Management of Living Resources programme, approved funding for the project Concerted Action for Complementary and Alternative Medicine Assessment in the Cancer Field (CAM-CANCER). The project’s objectives are (i) to integrate existing European initiatives for reviewing and summarising the evidence on CAM for cancer, (ii) to evaluate scientific evidence by performing systematic literature reviews and literature searches on CAM in the cancer field and (iii) to produce and disseminate suitable evidence-based information for health professionals in order to help them to inform their patients. In addition, the project will offer a European research network around CAM for cancer. The network will address several issues, such as the prevalence of the use of CAM for cancer in Europe, the regulatory difference among European countries and the policies of reimbursement of CAM by health insurances in Europe. Numerous articles on the topic are available and it makes sense to summarise the existing knowledge and update it if necessary.

The challenge of this project is to build an authoritative European network around CAM for cancer with an international panel of experts in CAM research and/or cancer care offering privileged contacts with cancer organisations. The first step is to gather professionals with different areas of expertise and backgrounds around the same table in order to define a common agenda, including objectives and methods. The CAM-CANCER project consortium is composed of eight partners. Among them, some specialise in medical literature review and others specialise in CAM research, cancer care, psychooncological issues, patient support and patient information. The consortium includes the Swiss Study Group on CAM in cancer supported by the Swiss Cancer League, the Association of European Cancer Leagues represented by the Norwegian Cancer Society and the Norwegian National Research Center in CAM, the Cochrane Cancer Network, the Complementary Medicine Unit, at the Peninsula Medical School–Universities of Exeter and Plymouth, the German Cancer Society, The Netherlands Cancer Institute, the Antoni Van Leeuwenhoek Hospital, the Study Group on Unconventional and Complementary Methods in Oncology at the Institut für Medizinische Onkologie, Hämatologie und KMT, Nuremberg, and the European Organisation for Research and Treatment in Cancer. In order to bring in additional, specific expertise and points of view, representatives of oncology nurses, CAM practitioners and cancer patients were appointed to the project Steering Committee.

The CAM-CANCER deliverables will include:

1. A website (www.cam-cancer.org) featuring information for health professionals and online collaboration tools for project collaborators. This website aims to provide a single access point for health professionals and cancer organisations searching for reliable information on CAM. The public area of the website is scheduled to be operational in autumn 2004.
2. Systematic reviews according to Cochrane Collaboration guidelines. The published literature will be searched in major and specialised databases. In order to avoid publication bias, the unpublished literature will also be searched in specialised and private databases. Five systematic reviews are ongoing and the results are expected before June 2005 (preventive and treatment efficacy of selenium, thymus extracts, psychological interventions, laetrile, CAM for breast cancer).
3. Peer-reviewed and up-to-date summaries of the existing scientific information on CAM in cancer (CAM Summaries). These will provide information on the background, promoter claims, safety issues and efficacy of a range of CAM modalities. The CAM Summaries will be available online on the project website. They are designed for use by health professsionals. The lay public will be strongly advised to discuss any information from the website with their physician or other health professional contact. We are planning to prepare 25 CAM Summaries by June 2005. The pilot phase is ongoing and will yield six CAM topics (shark cartilage, lacto-ovo vegetarian for gastro-intestinal cancer, Echinacea, Gerson diet, medicinal mushrooms, factor AF2).
4. Commented links. The project experts will assess the quality of external resources (websites, online articles, etc.). If these resources are considered valuable, the reviewers’ comments on this resource and an Internet link will be made available on the project website. The aim is to avoid duplication of work but also to benefit from the cumulative aspect of science. The Commented Links will allow an easy and quick access for the health professionals to selected high standard information.
5. Recommendations for searching and reviewing the evidence on CAM in cancer. This document will summarise partners’ experience in searching and reviewing data on CAM in cancer.