The goals of using alternative and complementary methods
Regarding oncological illnesses, I’d like to first begin with a categorical no to alternative medicine and yes to complementary therapies (see the above mentioned definition). Any method is justified if it alleviates symptoms and improves quality of life, but it absolutely cannot replace traditional treatment methods. We can conditionally accept the historical advent of ACM as the 1940s, when traditional oncological treatment methods became standard practice. It wouldn’t be fair to categorise attempts at therapy from earlier centuries as alternative, because standard methods had not yet been invented. However, it is encouraging that so many complementary methods have recently been the focus of well-conceived random trials.
The range of complementary methods is extensive and we can conditionally sort them into a number of groups:
1) direct effects on the body (osteopathy, massage);
2) traditional schools of medicine (Chinese medicine and Ayurvedic therapies, acupuncture);
3) methods that affect mind and body (meditation, hypnosis, prayer, yoga, a variety of art therapies);
4) organic methods (various diets, medicinal herbs, naturally-occurring ingredients, supplements);
5) energy therapy (the influence of fields of energy).
Of course, this isn’t a complete list, but the methods are myriad and we shouldn’t dismiss them all. If consulting with a homeopath and using the medicine he prescribes helps a patient feel better, then this is laudable, because we’re all aiming for the same goal. An art therapist, yoga instructor, physiotherapist, acupuncturist, aroma therapist, meditation teacher and others can all help and be a godsend to a patient. These days, while searching for evidence-based justifications, we often forget about the healing power of human interaction. This is especially important in oncology. In the following notes I’ll turn my attention to those complementary methods of therapy, which can be used either simultaneously with or after traditional treatment methods and which should be included in an integrated oncology plan.
Table 1. Differences in care in the private and public sectors.
|Time dedicated to a patient||15-20 minutes, often rushed, due to long queues. The doctor is often “unavailable” or takes care of personal problems in front of a patient, perhaps even using a mobile phone.||30-60-90 minutes for the first visit and at least 20 minutes for subsequent visits. There’s no sense of rush and patients can bring a friend or family member who will be welcome.|
|Environment||Clean and orderly, but impersonal. The environment isn’t conducive to a return visit. A major factor is also the attitude of staff when registering – is it polite or sympathetic?||Visibly appealing to make a patient feel comfortable and welcome. Even if there isn’t much space, each patient is greeted with a smile and some kind words, which play an invaluable role, especially if the patient is nervous or anxious.|
|Continuum of care||A cancer patient usually doesn’t have one doctor – one operates, someone else administers radiation, while another gives medication. In this multidisciplinary era no one doctor sees the entire disease or, for that matter, the patient.||A patient is generally attended to by the same doctor. Patients appreciate that one doctor makes all of the decisions regarding care, sending him to other specialists only when it is deemed necessary.|
|Interpretation of complaints and symptoms||Complaints and symptoms are interpreted based on the specific disease. Doctors usually don’t appreciate questions about a patient’s ailments that are not within their speciality. One gets the impression in Latvia that doctors rarely welcome questions by cancer patients.||The patient’s opinion is also taken into account, his ideas are heard and a detailed plan of action is explained including its potential effects on their wellbeing. The patient doesn’t have to feel guilty for not explaining something correctly, for not understanding the doctor or for asking questions.|
|Emotional attitude||Empathy is often lacking. Patients often complain about impolite staff, or doctors. Answers are often brusque, which are not conducive to a return visit and commonly lead a patient to lose faith in the healthcare system in general.||An attitude of empathy is essential. Politeness is the cornerstone of patient satisfaction.|
|Patient individuality||Is often ignored – yet another example of illness X.||A patient’s individuality is respected and taken into account.|
|Patient social status||Could be negatively connected to future care. Less time and attention is often given to patients of a lower social class. There are, of course, exceptions, but this upsets patients.||The “weak points” of a patient’s social status are carefully and delicately taken into account. For example, the compatibility of their income with the cost of treatment.|
|Communication||Often careless or incomplete, which often causes confusion and leads a patient to seek another opinion.||Often a precise, in-depth analysis of all details, active discussion to see if a patient has understood everything.|
|Relationship model||Paternalistic – the doctor knows that he’s the authority and the patient has to submit to his course of action without question.||More commonly geared toward the patient – a number of treatments are explained to the patient, including their advantages and shortcomings, and the patient’s opinion is taken into account.|
|Giving a prognosis||Usually evasive. It’s not uncommon for a patient to be misled by hard-to-understand statistical terminology or for certain topics to be avoided altogether.||More tolerant and understandable. The more information a patient is exposed to about the progression of his illness, the more willing he will be to accept a variety of different treatments.|
|Encouragement||The word “hope” might not be mentioned. The patient is afraid to ask questions about his prognosis, because he’s not convinced that the doctor will understand his concerns or give answers.||This usually plays a large role in the overall context. A prognosis is the most mercurial part of cancer and it has to be explained to the patient in a sympathetic manner.|