Complementary Medicine in A Palliative Care Context

About a year ago, I read a book on end of life, or palliative care called Being Mortal. Dr. Atul Gawande, a surgeon, professor, and prolific writer wrote the book. It discusses both common medical procedures and quality of life among older or very ill patients. He also wrote a companion article in the New Yorker that calls into question the high volumes of low value care that many people receive. Low value care can be very costly and does not actually make people better. Both of his pieces conclude that the conventional healthcare industry views the decline of old age as a problem that needs to be fixed. Alternatively, he suggests that we view the end of life as a natural progression. Indeed, it is part of life.

End of life care is a sensitive subject because we don’t like to think about our own death or that of our loved ones. However, we all know that we will have to deal with this difficult situation at some point! Complementary therapies, which focus on whole-person wellness, quality of life, mind-body connection and healing rather than fixing medical woes, are a natural fit in the context of palliative care. Dr. Gawande provides some information on complementary therapies in the context of end of life care, but mostly related to quality of life. As complementary medicine becomes more accepted in the field of cancer care and that of other serious illnesses, complementary therapies will have a larger role to play. Today we review the evidence for complementary medicine as part of palliative care.

Complementary Therapy Options in Palliative Care

A 2014 review of patients with a cancer of the chest found that about 42% of survey respondents used at least one type of complementary medicine. While that figure may differ depending on the type of cancer, and the therapy type, complementary medicine is common in palliative care. Indeed, the prevalence of use of complementary therapies among cancer patients is similar to the prevalence of use of the therapies among the general US population.

Often, complementary medicine is aimed at reducing pain, boosting the immune system, and controlling the side effects of the disease or decline in health. Rarely are complementary therapies sought to be a cure. A systematic review sought to quantify the effect of palliative care at end of life and found some evidence that complementary therapies can improve care at the end of life. Most studies, however, have not quantified the effect of complementary care. Measuring quality of life, for example, can be very difficult. Our pain series found that complementary therapies have a real effect on pain in a variety of settings.

Complementary therapies like acupuncture, massage therapy, dietary supplements and herbal medicines are options for patients at the end of life. Choosing any type of therapy at the end of life is a very personal decision. One clinician points out though, “the fact that more patients are currently seeing alternative medicine practitioners than primary care providers could be a sign of their dissatisfaction with the quality of their relationship with allopathic practitioners.”

Patient and Healthcare Provider Perspectives

In Germany, a series of surveys were conducted among doctors, nurses, and patients at a cancer treatment center. The surveys asked about the subjects’ interest in complementary therapies and where they get information about complementary therapies. Among those surveyed, 40% of patients, 85% of doctors, and 99% of nurses were interested in complementary therapies.

Clinicians got information about complementary therapies from their educational endeavors, while patients got information from media sources and their own social network. Patients and providers also differed in what types of therapies they were interested in. While patients were interested in biological methods, like dietary supplements, providers preferred mind-body therapies like yoga. There is a clear disconnect between patients and providers when it comes to complementary therapies, so improving communication and education for both groups is important.

Providers can do a better job of educating their patients on their options for care at the end of their lives. Rather than encouraging medical interventions, healthcare providers can use complementary therapies to improve their patients’ quality of life.

References

Bismark RS, Chen H, Dy G, et al. Complementary and Alternative Medicine Use Among Patients with Thoracic Malignancies. Supportive Care in Cancer. 2014; 22(7): 1857–1866.

Dorfman J, Denduluri S, Walseman K, Bregman B. The Role of Complementary and Alternative Medicine in End of Life Care. Psychiatric Annals. 2012;42(4):150–155.

Lorenz KA, Lynn J, Dy S. Evidence for Improving Palliative Care at the End of Life: A Systematic Review. Annals of Internal Medicine. 2008;148(2):147–159.

Mansky PJ, Wallerstedt DB. Complementary Medicine in Palliative Care and Cancer Symptom Management. Cancer J. 2006;12(5):425–31.

Muecke R, Paul M, Conrad C, et al. Complementary and Alternative Medicine in Palliative Care: A Comparison of Data from Surveys Among Patients and Professionals. Integrative Cancer Therapies. 2015.

Pan CX, Morrison RS, Ness J, et al. Complementary and Alternative Medicine in the Management of Pain, Syspnea, and Nausea and Vomiting Near the End of Life: A Systematic Review. Journal of Pain and Symptom Management. 2000;20(5):374–387.