Supporting the

Neuroendocrine Cancer Community

Complementary and Alternative Medicines (CAMS)

COMPLEMENTARY THERAPIES

There’s no universally agreed definition of CAMs. Although “complementary and alternative” is often used as a single category, it can be useful to make a distinction between the 2 terms.

The US National Center for Complementary and Integrative Health (NCCIH) uses this distinction:

  • When a non-mainstream practice is used together with conventional evidence-based medicine, it’s considered “complementary”.
  • When a non-mainstream practice is used instead of conventional evidence-based medicine, it’s considered “alternative”.

However, there can be overlap between these categories. For example, aromatherapy may sometimes be used as a complementary treatment, and in other circumstances is used as an alternative treatment. (adapted from NHS website: https://www.nhs.uk/conditions/complementary-and-alternative-medicine/ )

Before we talk further about CAMS – what is evidence-based medicine?

Untested and/or unsupported theories or claims about any treatment – conventional or not, however convincing they may sound – are not enough to be able to assume safety, efficacy and effectiveness – and may, indeed, prove harmful.

Evidence-based medicine is the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients. Sackett et al (1996) Evidence based medicine: what it is and what it isn’t BMJ ;312:71

The wording in the above definition is important:

  • Conscientious: acting in a way that is very thorough and careful – a moral responsibility to undertake work carefully and to be fair to others.
  • Explicit: something that is stated clearly and in detail, leaving no room for confusion or doubt-showing full details, without anything hidden or suggested.
  • Judicious: using considered judgement – having or showing reason and good judgment in making decisions: and Evidence: the available body of facts or information indicating whether a belief or proposition is true or valid – in medicine this evidence is supported by valid scientific research.

Evidence-based practice requires that decisions about health and social care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources

Dawes et al. (2005) Sicily statement on evidence-based practice. BMC Medical Education. 2005; 5:1

Complementary Therapies

Complementary therapies in cancer are considered as those “which are used alongside conventional cancer treatments”.

Question you can ask your CAM therapist

  • How many years of training have you had?
  • How long have you been practising?
  • Have you had training for treating and supporting people with cancer?
  • Are you a registered practitioner? (name of registration organisation)
  • Do you have indemnity insurance? (in case of negligence)
  • What benefits can I expect from using the therapy and are there any side effects?
  • Will the therapy interact with any medications I am currently having?
  • How soon can I expect to see some benefit from the therapy?
  • How long will the course of therapy be and how much it will cost?
  • Where can I find out more information about this therapy?

Many of the therapies, listed below, may be accessed either via the NHS or through cancer centres – including Maggie’s and/or Macmillan centres.

 

Choosing a Practitioner

Practitioners should be trained and qualified with an accredited body in their chosen field and be fully insured. This post-graduate training should have covered working with people affected by cancer – and practitioners are to be mindful of the vulnerability of those seeking and/or receiving care.

The Complementary and Natural Healthcare Council set the standards that practitioners need to meet to get onto and then stay on the register. All CNHC registrants have agreed to be bound by the highest standards of conduct and have registered voluntarily. All of them are professionally trained and fully insured to practise.

Explanation of complementary medicines – including claims of effectiveness – should match the standards by which conventional medicines and treatments are held : untested and/or unsupported theories or claims about any treatment – conventional or not, however convincing they may sound – are not enough to be able to assume safety, efficacy and effectiveness – and may, indeed, prove harmful.

The IFPA in their code of practice state.

The term ‘complementary medicine’ makes no pretensions of replacing conventional medicine; it informs the public that aromatherapy cannot and does not ever exclude conventional medicine and orthodox healthcare practitioners from patient care and treatment.

CRUK list of resources and organisations, including regulatory bodies on their website here.

CRUK advice on CAMS here.

The Health and Care Professionals Council (HCPC) are the regulatory body for 15 health and care professionals – art therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dieticians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists/orthotists, radiographers and speech & language therapists.

 

involves the insertion of very fine needles into specific points on the body to affect the flow of your body’s qi, or vital energy.

For further information British Acupuncture Council a member of the Accredited Register scheme run by the Professional Standards Authority (PSA).

is the use of essential oils to improve health and wellbeing. Some essential oils can affect how well certain medications or therapies work.

nb In the UK aromatherapists may only treat you with essential oils by letting you inhale it or apply it to your skin. In France and Germany therapists may use essential oils orally and internally.

Do not swallow an essential oil or put it inside any other part of the body (eye, ear, nose, anus or vagina).

For further information International Federation of Professional Aromatherapists

is a form of psychotherapy that uses art media as its primary mode of expression and communication. Within this context, art is not used as diagnostic tool but as a medium to address emotional issues which may be confusing and distressing.

For further information British Association of Art Therapists BAAT members are qualified art therapists, regulated by the Health and Care Professions Council (HCPC) and HCPC registration is a statutory requirement in the UK for arts therapist.

uses hypnosis to put you into a trance like state where your body is deeply relaxed but your mind is active : some people with cancer use hypnotherapy to help them relax and cope with symptoms and treatment.

For further information British Society of Clinical Hypnosis – the CNHC has agreed that the BSCH may verify applications for CNHC registration.

is a technique that applies pressure to parts of the body by stroking, kneading, tapping or pressing. It aims to relax you mentally and physically.

n.b. People with cancer should avoid very deep massage.

Always talk to your cancer doctor or specialist nurse before using any type of commercial massage therapy. An adapted treatment offered from a therapist in a cancer care centre or hospice might be more appropriate for you.

Avoid massaging any area of your body where you are having radiotherapy to. And don’t have massage to areas where your skin is broken, bleeding or bruised.

You should avoid general massage therapy to your arms or legs if they are swollen because of lymphoedema.

Lymphoedema is a build up of fluid due to the lymphatic system not draining properly. This might be a result of surgery to remove the lymph nodes, or damage to the lymph nodes or lymphatic vessels from radiotherapy.

Manual Lymphatic Drainage (MLD) is a very specialised treatment and people who need MLD are referred to a lymphoedema specialist by their doctor or specialist nurse.

(source : CRUK )

The Complementary and Natural Healthcare Council (CNHC) is the regulatory body for Massage Therapies in the UK

uses music and sound to help express emotions and improve emotional and physical well being. Music therapists often work alongside other healthcare professionals such as doctors, nurses, speech therapists, psychologists and psychiatrists.

For more information British Association for Music Therapy regulated by the Health and Care Professions Council (HCPC).

is a complementary therapy that applies gentle pressure to the feet or hands to stimulate energy pathways in the body.

Further information Association of Reflexologists – reflexologists are registered with the Association of Reflexologists or the Complementary and Natural Healthcare Council (CNHC).

has been defined as “A healing technique based on the principle that the therapist can channel energy into the patient by means of touch, to activate the natural healing processes of the patient’s body and restore physical and emotional well-being”.

The UK Reiki Federation states that “Reiki supports orthodox medicine or can be used alone but is not a replacement for traditional medication or treatments”.

Further information UK Reiki Federation formally approved by the CHNC as a verifying organisation for Reiki practitioners wishing to apply for CNHC registration.

according to the Shiatsu Society – shiatsu means ‘finger pressure’ in Japanese, in practice a practitioner uses touch, comfortable pressure and manipulative techniques to adjust the body’s physical structure and balance its energy flow. It is a deeply relaxing experience and regular treatments can alleviate stress and illness and maintain health and well-being.

Further information The Shiatsu Society (UK) In the UK, registering as a shiatsu therapist is voluntary and coordinated by the Complementary and Natural Healthcare Council (CNHC).

combines deep breathing with flowing movements as a moving meditation, it can help to reduce stress and anxiety, and improve general health and wellbeing.

For further information The Tai Chi Union

nb many Maggie’s Centres and Macmillan hubs, alongside other cancer support centres offer Tai Chi amongst their timetabled activities.

as therapy uses the tools that you would find in many Yoga classes; postures, working with the breath, meditation, awareness of the body and/or mind, relaxation, and these are directed to the needs and ability of the person concerned.

For more information British Council for Yoga therapy Yoga Therapists who have completed an Accredited Yoga Therapy training course can apply to the CNHC’s voluntary register.

NB we would caution that cannabis is a class B drug and illegal in the UK.

There has been a lot of interest into whether cannabinoids might be useful as a cancer treatment. The scientific research done so far has been laboratory research, with mixed results, so we do not know if cannabinoids can treat cancer in people. (CRUK)

However, whilst its use as a treatment for cancer is unproven, there are a several trials currently underway in the UK looking at its use in symptom control. Further information about cannabis, CBD oil and these trials is available here.

There are a number of ‘nutritional’ therapies that can be found on the internet – however, given the complexity and variety of potential effects on the body of Neuroendocrine Cancer – and its treatments – we would strongly recommend that anyone affected by Neuroendocrine Cancer seeks nutritional and dietary advice from a qualified and registered dietician – with experience and expertise in working with people with Neuroendocrine Cancer.

Dieticians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard.

Only those registered with the statutory regulator, the Health & Care Professions Council (HCPC) can use the title of Dietitian/Registered Dietitian (RD)

Minimum requirement : a BSc Hons in Dietetics, or a related science degree with a postgraduate diploma or higher degree in Dietetics.

The British Dietetic Association is the professional body and Trade Union for dieticians and is also responsible for designing the curriculum for the profession.

Courses must be approved by the HCPC and demonstrate that graduates meet the Standards of Proficiency for Dietetics.

Further information about dieticians and the key differences between dieticians – nutritionists, nutritional therapist and ‘dietary experts’ can be found here.

NCUK diet and nutrition page – including video presentations – created in collaboration with Neuroendocrine Cancer dieticians and is available here.

General healthy eating:

“Exercise is the best medicine someone with cancer can take in addition to their standard cancer treatments. That’s because we know now that people who exercise regularly experience fewer and less severe treatment side-effects; cancer-related fatigue, mental distress, quality of life.”

“If the effects of exercise could be encapsulated in a pill, it would be prescribed to every cancer patient worldwide and viewed as a major breakthrough in cancer treatment,”

Associate Professor Prue Cormie, Chair of the Clinical Oncology Society of Australia Exercise Cancer Group.

Staying active during and after cancer treatment makes a lot of sense. It can boost your energy levels and your mood. It can help your bones, muscles and heart to stay strong. It can help you to stay at a healthy weight. It can help you to sleep better and improve your appetite. And it can increase your range of movement and control side effects like constipation.

Your care team can advise you on how much exercise is right for you. This may depend on:

  • How active you were before your diagnosis
  • The type of NET/NEC you have
  • The treatment you’re having or have had
  • Any side effects or longer-term consequences you may have
  • Whether you have any other health problems

This is not an exhaustive or complete list of the complementary therapies that may help someone diagnosed and living with cancer – but we hope it provides an overview of the more common complementary techniques and treatments available.