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CAM and Cancer: The Key is Communicating

According to a spate of recent surveys, over the last decade Americans have not only embraced complementary and alternative medicine (CAM) to promote vitality and good health but also to fight chronic conditions, such as arthritis and menopause. Now new research shows that a majority of cancer patients--estimated from 50% to a whopping 83%--are also turning to CAM therapies (herbs, vitamins, soy, acupuncture, relaxation training, guided imagery) in an effort to round out their conventional cancer care.

This decision can have real benefits, since CAM therapies are often very effective in easing symptoms like pain and the nausea associated with chemotherapy. Alternative therapies can also help build a sense of personal empowerment and well-being that cancer patients often crave. On the other hand, alternative medicine can be problematic, primarily since more than half of patients using complementary therapies don't tell their doctors they're doing it. According to the findings of a recent study in the medical journal Psycho-Oncology, this lack of communication can have serious ramifications, particularly if you have a serious condition such as cancer.

Three key issues

The current Psycho-Oncology study identified three specific issues hampering good doctor-patient communication concerning CAM:

 Indifference or opposition. Many patients have felt their physicians lacked interest in CAM, showed little empathy, or were unwilling to discuss it. They reported a range of responses from hidden disapproval to active opposition (even for supportive forms of CAM, such as massage, that have little potential for adverse effects).

 Scientific emphasis. By training, physicians are required to base their medical decisions on stringent scientific evidence. Because many CAM approaches have not been conclusively "proven" by Western scientific methods, they are often not on a physician's radar. Likewise, patients are not accustomed to evaluating health decisions solely on the basis of statistics and hard evidence, such as percentages of mortality or longevity.

 Fear of a negative response. Sometimes patients don't disclose their use of CAM, or raise the topic for discussion, because they anticipate that their doctors will be skeptical, tell them to stop, or have another negative response. Others avoid the issue because they fear making a negative impression.

The Keys to Openness

According to Chicago's Dr. David Edelberg, WholeHealthMD’s chief medical advisor, "Although it’s essential for patients to be open with their doctor about their CAM use, they shouldn't necessarily expect approval for a therapy their physician may not understand." Edelberg further counsels that if you intend to use CAM, "begin by saying something like: 'Doctor, I want to explore all my alternatives. I certainly intend to continue the treatment you are providing, but I plan to look at CAM therapies as well. If you'd like, I'll bring you information about them.' This way, you’re not asking permission, but alerting your doctor to your intentions." After all, Edelberg adds, "It’s your life you’re trying to preserve. You ultimately call the shots."

According to the Psycho-Oncology study, a good physician-patient interaction should include the following elements:

 Active give and take. The doctor should ask about and listen to a patient’s description of CAM choices and use. If side effects or interactions are a concern, the physician should provide relevant information.

 Open discussion. Pros and cons, and risks and benefits, should be openly discussed between doctor and patient.

 Empathy and support. Regardless of the physician’s opinion of specific CAM approaches, the patients' effort to improve their condition should be compassionately supported.

 Sensitivity to underlying issues.. Knowing why a patient is searching out CAM alternatives may allow a physician to offer additional help for unmet needs, such as counseling or social support.

Finding Common Ground

Most experts agree that communication characterized by compassion, support, and mutual respect will go a long way toward increasing patients’ satisfaction with their doctors. And, in the end, fostering openness and trust between patient and physician can only benefit the healing process.

Just as physicians educate their patients about treatments and risks, patients can educate their physicians about specific CAM therapies. Start by discussing forms of CAM that your doctor is probably familiar with. Most physicians, for instance, now sanction support groups, massage, yoga, and sometimes even acupuncture, which has been proven to counteract pain and nausea.

"Your physician may not be well-versed in herbal or nutritional therapies, but when you learn about these on your own and bring in the information, you can discuss them together," says Dr. Edelberg. "On the other hand," he continues, "if you say, 'I think I want to travel down to Tijuana for some cancer therapy I saw on an infomercial,' you'll probably stop the conversation cold. Even so, if you have established a good open relationship, your doctor should be able to give you insight on why this may not be a wise choice."

According to Edelberg, "The cancer patients who do extraordinarily well are the feisty ones-the ones who take charge and are proactive, not those who are totally compliant." Edelberg also suggests that it's this feisty attitude that opens the communications channels, and that ultimately it's good communications that can make a significant difference in a patient's quality of life during and following treatment for cancer.

Date Posted: 09/01/2002

Date Published: 08/31/2002
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