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CAM and Cancer Care: An Overview
Jeri O’Dowd RN BSN CTM RYT
ACHS Capstone Project
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
Objectives:
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
What is CAM?
“Complementary” generally refers to
using a non-mainstream approach
together with conventional
medicine.
“Alternative” refers to using a nonmainstream 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”
CAM Past to Present
•  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?
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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: Advantages / Disadvantages
•  Advantages
•  Disadvantage
–  Access
–  Stigma
–  Cost
–  Insurance
–  Safety / Efficacy
–  Safety / Efficacy
–  Regulations / Quality
Control /Certifications
What is Considered CAM?
•  CAM modalities are classified by category
–  NCCAM
–  OCCAM
The National Center of
Complementary and Alternative
Medicine
“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
NCCAM’s 2 Main Categories
•  Natural
Products
(Biologically
based):
–  Herbs
–  Vitamins /
Minerals
–  Probiotics
•  Mind Body Practices:
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Acupuncture
Massage Therapy
Hypnotherapy
Spinal Manipulation
Tai Chi
Qi Gong
*Healing Touch
*Meditation
*Relaxation Techniques
**YOGA
NCCAM’s Additional Category:
•  Alternative Medical Systems:
–  Ayurvedic Medicine
–  Traditional Chinese Medicine
–  Homeopathic Medicine
–  Naturopathic Medicine
Office of Cancer Complementary
and Alternative Medicine
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
OCCAM’s Categories
Domain Examples Alterna(ve Medical Systems Energy Therapies Ayurveda, Tradi(onal Chinese Medicine, Acupuncture, Homeopathy, Naturopathy, Tibetan Medicine 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 Nutri(onal Therapeu(cs Medita(on, Art therapy, imagery, relaxa(on techniques, aromatherapy, pet therapy 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 CAM Use in Oncology
•  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
The Role of the Oncology Nurse
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
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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 herbchemotherapy reactions:
1.  Garlic
2.  Echinacea
3.  Gingko
4.  Soy
5.  Ginseng
6.  St. John’s Wort
7.  Grape Seed
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 Where to go for Guidance
•  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-andcancer-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-statementsdecision-trees/complementary-therapies.pdf
Conclusion
Summary
Questions
Evaluation Form
Energize with
Breath of Fire and
essential oils
References
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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
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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
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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.