By Richard A. Zmuda, cancerpage.com
　　In a remarkable article appearing in the August 15, 2000, issue of the journal Cancer, Dr. Wolfgang Sollner and colleagues from University Hospital in Innsbruck, Austria wrote that the use of complementary and alternative medicine is actually a positive sign that patients are actively coping with their disease, rather than a signal of their frustration with conventional care.

In a survey of 172 patients undergoing traditional surgical, radiation and chemotherapy treatments for their cancers, the researchers found that patients using complementary or alternative therapies were more "information-seeking and problem-solving" toward the treatment of their disease, and they received high marks for their compliance with standard treatment regimens.

Surprisingly, in spite of their use of complementary and alternative therapies, these same patients also said they "maintained a high trust" in conventional medicine.

The researchers noted that many oncologists still fear that the use of non-conventional treatments may lead patients to abandon standard medical care. On the contrary, Sollner asserted, their findings "suggest that cancer patients consider complementary and alternative therapies supplementary to standard medical methods and one way of avoiding passivity and of coping with feelings of hopelessness."

While the Austrian study rebuts conventional wisdom about why patients turn to complementary and alternative therapies, there is absolutely no controversy surrounding its explosive growth.A Booming Industry

When the Journal of the American Medical Association reported back in 1998 that patient visits to complementary and alternative medical practitioners had increased by 47 percent between 1990 and 1997, many in the medical community were shocked. Not anymore.

Hundreds of hospitals now have complementary and alternative medicine (CAM) programs in full operation. And a study by the Columbia University College of Physicians and Surgeons found that CAM courses are now offered at 75 of the 125 accredited U.S. medical schools; 19 medical schools and medical centers even offer post-graduate courses for practicing doctors. The budget for the National Center for Complementary and Alternative Medicine at the National Institutes of Health has grown from $2 million in 1993 to $68.7 million this year.

According to one study, Americans spent $27.2 billion in 1998 on providers of alternative health care, including those in chiropractic, traditional Chinese medicine, homeopathy, naturopathy and massage therapy. Sales of herbs are also growing, to $4.4 billion in 1998 from nearly $2.5 billion in 1995. And these numbers are expected to skyrocket in the coming years.Lack of Disclosure

Nonetheless, many cancer patients are using complementary and alternative therapies without telling their doctors.

In a study published in the Journal of Clinical Oncology, researchers from the University of Texas found that 99.3 percent of outpatient cancer patients at the school's M.D. Anderson Cancer Center had heard of complementary and alternative medicine, and 83.3 percent had tried at least one approach.

However, about 60 percent of these patients said they did not discuss alternative and complementary therapies with their doctor, although when interviewed in more detail about individual therapies, this rate dropped to a lower-but still significant-38.2 percent.

According to study's author, Dr. Mary Ann Richardson of the National Center for Complementary and Alternative Medicine at the National Institutes of Health, "Whether we call these approaches medicines, alternatives, complementary approaches, or natural herbal remedies, interest in them is here to stay."

Richardson and her colleagues interviewed 453 patients undergoing cancer treatments at one of eight clinics at M.D. Anderson. When they excluded psychotherapy and spiritual practices, they found that 68.7 percent of the patients reported using at least one unconventional therapy. Of these, 38.3 percent had used herbs like essiac tea, mistletoe and ayurveda, while 60.3 percent had used vitamins, including melatonin and shark or bovine cartilage.

Richardson's team found that users of complementary and alternative therapies tended to be female, younger, and with more advanced disease. Reasons cited for their use of such therapies included a desire to improve quality of life, to boost the immune system and to prolong life. More than a third (37.5 percent) said they had turned to these therapies as a cure for their cancer.

In a presentation at the recent annual meeting of the American Society for Clinical Oncology in New Orleans, Dr. James Metz of the University of Pennsylvania Cancer Center found that cancer patients who use unconventional medical treatments only tell their doctor when specifically prompted to do so.

Of the 196 cancer patients interviewed in the study, only 13 percent revealed their use of unconventional medicines-defined as those not proven in the eyes of the medical profession-when asked about over-the-counter and prescription drugs. But when given specific questions about the use of vitamins, herbal supplements, shark cartilage and therapies such as guided imagery music or medication, a total of 92 percent admitted they did.

Metz expressed concern that many of these treatments could interfere with conventional therapies that are being prescribed. For example, vitamin A has been linked to an increased risk of stomach cancer, and concerns have been raised about the interaction of St. John's Wort with certain medicines. Vitamins C and E are antioxidants that could interfere with or inhibit radiation treatment. And many supplements can skew the results of laboratory tests.Physician's Share the Blame

Many doctors are surprisingly unaware of the use of complementary and alternative treatments by their patients. In one study of prostate cancer patients by Dr. Gary Kao of the Hospital of the University of Pennsylvania and Pamela Devine of the Department of Veterans Affairs Medical Center in Philadelphia, 37 percent of the patients were found to be using at least one complementary health practice. However, the physicians estimated that only 4 percent of their patients used such therapies.

Writing in the journal Cancer, Kao and Devine said that the danger of such a wide communication gap is that many patients are making their own conclusions regarding how the complementary treatment would interact with conventional medicines in the absence of specific instructions by their healthcare provider.

Interestingly, in a report published in The Journal of Alternative and Complementary Medicine, Dr. Ira Wilson of the New England Medical Center in Boston noted that two-thirds of physicians say they believe that complementary and alternative therapies may help some patients. In addition, 36 percent reported that they personally had used such therapies.

In any case, contends Dr. Wayne Jonas of the Uniform Services University of the Health Sciences in Bethesda, Maryland, "There is a certainly a communication gap between doctors and patients." He recommends four points that physicians should consider in relation to alternative medicine:Physicians should know enough about the types of alternative treatments that their patients use in order to protect them from harmful practices.Physicians should permit their patients to use those treatments that are unlikely to produce adverse effects as long as patients don't use them in place of conventional care.Physicians should promote alternative treatments that they know to be safe and effective.Physicians should work with their patients and closely monitor the course and outcome of any treatments they use.
　　
　　
　　(From HealthWorld Online)