CAM and Cancer Care: An Overview Jeri O Dowd RN BSN CTM RYT

Transcription

1 CAM and Cancer Care: An Overview Jeri O Dowd RN BSN CTM RYT

2 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

3 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

4 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?

5 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

6 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

7 CAM Past to Present Why the increased interest and usage, specifically among cancer patients? 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

8 CAM: Advantages / Disadvantages Advantages Access Cost Safety / Efficacy Disadvantage Stigma Insurance Safety / Efficacy Regulations / Quality Control /Certifications

9 What is Considered CAM? CAM modalities are classified by category NCCAM OCCAM

10 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.

11 NCCAM s 2 Main Categories Natural Products (Biologically based): Herbs Vitamins / Minerals Probiotics Mind Body Practices: Acupuncture Massage Therapy Hypnotherapy Spinal Manipulation Tai Chi Qi Gong *Healing Touch *Meditation *Relaxation Techniques **YOGA

12 NCCAM s Additional Category: Alternative Medical Systems: Ayurvedic Medicine Traditional Chinese Medicine Homeopathic Medicine Naturopathic Medicine

13 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.

14 OCCAM s Categories Domain Alterna(ve Medical Systems Energy Therapies Exercise Therapy Manipula(ve and Body based methods Mind- Body Interven(ons Nutri(onal Therapeu(cs Pharmacologic / biologic Complex natural products (subcategory of above) Spiritual Therapies Examples Ayurveda, Tradi(onal Chinese Medicine, Acupuncture, Homeopathy, Naturopathy, Tibetan Medicine Qigong, Reiki, therapeu(c touch Tai Chi, Hatha Yoga, Dance Therapy Chiroprac(c, massage, reflexology Medita(on, Art therapy, imagery, relaxa(on techniques, aromatherapy, pet therapy Macrobio(cs, veganism, Vitamins, an(oxidants Mistletoe, high dose Vitamin C, products from honey bees Botanicals, herbs, herbal extracts, tea polyphenols, shark car(lage Prayer, Spiritual Healing

15 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

16 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

17 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)

18 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 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

19 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

20 Where to go for Guidance? Agency American Cancer Society OCCAM NCCAM Society for Integra(ve Oncology ONS American Holis(c Nurses Assoc. MD Anderson Cancer Center: Integra(ve Medicine Department Arizona Ctr. for Integra(ve Medicine Duke Integra(ve Medicine Memorial Sloan KePering Cancer Center Integra(ve medicine Natural Medicines Comprehensive Database Website hpp:// hpp://cam.cancer.gov/about_us.html hpp://nccam.nih.gov/ hpp:// docguide hpps:// hpp:// hpp:// hpp://integra(vemedicine.arizona.edu hpp:// hpp:// care/ integra(ve- medicine hpp:// naturaldatabase.therapeu(cresearch.com

21 Where to go for Guidance Guidelines Society of Integrative Oncology s Evidenced Based clinical Practice Guidelines for Integrative Oncology American Cancer Society s Guidelines for Using Complementary and Alternative Methods complementaryandalternativemedicine/ complementaryandalternativemethodsandcancer/cam-andcancer-toc

22 Where to go for Guidance Position Statements Oncology Nursing Society: The Use of Complementary and Alternative Therapies in Cancer Care: positions/alternativetherapies.pdf American Holistic Nurses Association: Position on the Role of Nurses in the Practice of Complementary and Alternative Medicine North Carolina State Board Of Nursing: Complementary Therapies Position Statement for RN and LPN Practice

23 Conclusion Summary Questions Evaluation Form Energize with Breath of Fire and essential oils

24 References AHNA. (2014). Position Statements. Retrieved from American Holistic Nurses Association: American Cancer Society. (2014). Complementary and Alternative Methods and Cancer. Retrieved from American Cancer Society: 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, Decker, G. M., & Lee, C. L. (2010). Handbook of Integrative Oncology Nursing: Evidence-Based Practice. United States of America: Oncology Nursing Society.

25 References 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: North Carolina Board of Nursing. (2009, November). Position Statements: Complementary Therapies. Retrieved from North Carolina Board of Nursing: Oncology Nursing Society. (2009, March). Oncology Nursing Society: The Use of Complementary, Alternative, and Integrative Therapies in Cancer Care. Retrieved from Oncology Nursing Society: 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,

26 References 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: 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: 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, 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.