Page 2530 - Hematology_ Basic Principles and Practice ( PDFDrive )

C H A P T E R 156

INTEGRATIVE THERAPIES IN PATIENTS WITH

HEMATOLOGIC DISEASES

David S. Rosenthal, Ann Webster, and Elana Ladas

Complementary and alternative medicine (CAM) is tremendously therapies (http://www.nccih.nih.gov). Many hematology/oncology
popular in the United States and many parts of the world to help centers have established IM programs where complementary therapies
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people with wellness and health. In the United States alone, an such as acupuncture, massage, nutrition, physical activity, and stress
estimated $36 to $47 billion is spent annually by the public on CAM management are offered alongside the conventional therapies of
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methods of therapy, and in a National Health Interview Survey in chemotherapy, radiation, and targeted therapies. These programs
2007 and again in 2015, 37% of adults used at least one form of provide guidance to patients in choosing the safest and most effective
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CAM. Over the past decade, CAM practices have become even more integrative therapies that could be incorporated into their plans of
popular, especially in individuals with a chronic disease such as care. Despite the level of evidence supporting standard treatment,
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hematologic malignancies and cancer. In 1998 the National Center some patients decline chemotherapy, radiation, or surgery. Instead,
for Complementary and Alternative Medicine (NCCAM) was estab- they choose to pursue an alternative therapy. Sometimes this choice
lished at the National Institutes of Health (NIH) to study the efficacy is because of a cultural belief, because they believe that natural
and safety of CAM practices. The term CAM caused consternation products are potentially less toxic, or because they believe that the
among many in the field, who perceive that their patients are forgoing alternative treatment will offer a “cure” for their disease. Alternative
conventional therapy. That is generally not the case. The term CAM medicine practitioners and clinics exist in our country and around
is controversial because the words complementary and alternative the world that offer a “cure,” usually for a significant amount of
have completely different meanings and should not be connected by out-of-pocket fees. Unfortunately, these clinics rarely ever provide any
an “and” but by an “or.” Whereas complementary therapies were scientific evidence and typically do not conduct research or report
defined by NCCAM as therapies used to complement or to be used their results except in advertisements.
alongside conventional methods of therapy, alternative methods On the other hand, there is an increasing body of research on the
referred to those therapies used instead of known conventional thera- benefits of many complementary and integrative therapies. Clinical
pies and have not been shown to be effective. The term integrative studies provide evidence that some integrative therapies are beneficial
medicine (IM) or integrative health (IH) is used to more accurately to patients by improving their quality of life, reducing their symptoms
describe the complementary therapies being used in US medical from the disease, and decreasing the side effects from treatment. One
settings today. These therapies are used alongside conventional thera- of the major concerns, however, is the use of botanicals, herbs and
pies in a therapeutic environment. In 2014 NCCAM was renamed over-the-counter (OTC) drugs in conjunction with chemotherapy
“The National Center for Complementary and Integrative Health and radiation therapy (see later). Some may reduce the effectiveness
(NCCIH),” which more accurately reflects the work as only a minor- of certain chemotherapies, and others may reduce metabolism of an
ity of individuals are forgoing conventional therapies. The compo- active drug, enhancing its potential toxicity.
nents of IM or IH (1) combine the best of both conventional and
evidence-based complementary therapies, (2) emphasizes patient
participation, (3) promote the primacy of the patient–provider rela- INTEGRATIVE THERAPY DOMAINS AND THEIR USE
tionship and the importance of shared decision making, (4) empha-
sizes the contribution of the therapeutic encounter itself, and (5) According to the NCCIH, “most integrative therapies fall into one
optimizes the individual’s innate healing capacity. 5 of two subgroups—natural products or mind and body practices”
Although many integrative therapies such as acupuncture, (Table 156.1). There is also an abundance of whole-systems practices
massage, and meditation are quite beneficial for hematology/oncology that include ayurvedic medicine and traditional Chinese medicine.
patients by helping them to cope with the disease, reducing their The whole-systems approaches incorporate many of the integrative
stress and symptoms related to the conventional therapy or to the therapies. Mind–body approaches include meditation, mindfulness
disease process itself, many alternative interventions are unproven and meditation, guided imagery, music therapy, creative arts therapy,
could be harmful for patients who may believe that these interven- self-hypnosis, yoga, tai chi, and qigong, among many other types of
tions can cure them of their malignancy. An American Cancer Society physical and spiritual practices. Energy-based therapies include reiki
study concluded that as many as 61% of cancer survivors used some and healing touch. Body-based manipulative therapies include chiro-
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form of complementary or alternative therapies. In addition, the practic and massage therapy. Examples of natural products include
majority of people do not share their use of these therapies with their dietary supplements, antioxidants, vitamin megadoses, specialized
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primary care providers. According to a survey by Eisenberg et al, diets, and herbs.
patients do not think that their physicians need to know about their In the literature, there is a paucity of information on the use of
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use of these interventions and many patients responded that their integrative therapies in the treatment of hematologic malignancies.
physician never asked about such use. Because there are many poten- In India there is a significant use of ayurvedic medicine. In a German
tial drug–drug, drug–herb, drug–radiation, and antioxidant–drug study of a large group of patients with chronic lymphocytic leukemia
interactions, it is extremely important for patients to share their use (CLL), approximately 44% used integrative therapies with 26%
of integrative therapies and alternative treatments with their providers using vitamin supplementation, 18% mineral supplementation, 14%
and similarly for physicians to ask about their patients’ usage. 7 homeopathy, 7% acupuncture, and 9% mistletoe therapy. In the
Through the NCCIH and IM centers, more information and United States, 30% to 80% of pediatric hematology/oncology
education is available to the public and to physicians, on the impor- patients used one or more complementary therapies in conjunction
tance of physicians’ “asking” about the use of integrative therapies with their conventional care. In the US pediatric group, there is an
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and alternative therapies and patients “telling” about the use of these especially high use of vitamin and nutritional supplements, with
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