I finished the previous blog two weeks ago, after having radiotherapy to the lesions in my brain, and feeling pretty positive again. And while trying to ignore the swelling in my left leg.
It couldn’t be ignored for very long, and by that afternoon I was diagnosed with another complication of cancer, a deep vein thrombosis. This is a blood clot that forms in the deeper, inside veins of the leg and in my case the thigh. It can occur in other situations besides cancer, such as after surgery or a period of long immobility and it can be dangerous, because part of the clot can break off and go to the lung. I was started on treatment the same day, and hopefully this complication will also resolve but it takes time before but it gets better. I really would appreciate having a period of boredom for a while!
I keep repeating this, but once again, the treatment team has been incredibly helpful. It is reassuring for me to start mobilizing and exercising under their supervision, and to be reassured by the outcomes that they have seen in many other patients with the same problem. However the acupuncturist was on a well-deserved vacation, and I have been relying on him to help me both with some of my physical symptoms and also with some of the emotional stress I have been going through.
This has led me to look at some of the evidence for complementary and alternative therapies for cancer. I have not done a complete literature review, so these comments are based on my own experiences, those of my friends, and on a few articles.
First, it seems that at least 40% of cancer patients use some form of complementary and alternative medicine (CAM). It may help patients by giving them strength to go through difficult treatments; it may improve quality of life and may relieve some symptoms.
One article that summarized the systematic reviews found that that there was some evidence for the benefit of certain interventions such as psychoeducational intervention, music intervention, and acupuncture with drug therapy for pain relief in cancer. However the quality of most of the studies was poor and the authors could not recommend any specific CAM for pain control.
Another review of acupuncture found that there was consensus on its use for chemotherapy induced nausea and vomiting and some evidence for a positive effect in other cancer-related symptoms such as hot flashes, xerostomia (dry mouth), fatigue, anxiety, dyspnea and pain and maybe hiccups. The authors noted the use of acupuncture for symptoms with limited treatment options and once again discussed the difficulty in carrying out high quality studies in this field.
There is a difference between using CAM as an alternative to traditional therapy, which can clearly be dangerous, and as an adjunct to traditional treatments. It is crucial for the treating team to be aware of everything that a patient is taking and doing, as there can be important drug interactions and certain interventions have risks. It seems to me that the best way to allow this communication to occur is for at least certain of the therapies to be offered within the treatment program and importantly for the treating team to ask each patient, and be up to date on current treatments and the evidence for and against those treatments. In my situation, I have read about various diet recommendations for lung cancer –my dietician was in each case aware of the diet and the most recent evidence for and against their benefit. Similarly, my acupuncturist is aware of all the Chinese herbal remedies and the most recent studies that have been carried out on them.
This is reassuring to me as a patient. It tells me that the team is not rejecting a claim of health benefit without at least finding out what the information is to support or refute its claim, and that these subjects are being discussed by the treating team. It allows me to ask about claims openly, without feeling foolish, and it acknowledges that certain treatments can help me feel better, whether or not the data do support it. While I certainly do accept the need for high quality studies of interventions, I am not certain that the outcomes being measured in those studies are always the most appropriate. I find that the benefit of these interventions for me is related to time with a knowledgeable and empathetic provider, relaxation, reassurance, and meeting other patients. There is also a benefit to having some decision-making capability over what I do; so much of my treatment is managed by the doctors and out of my direct control, but in this case I feel that I am the one deciding whether the treatment benefits me how often I need them.
It is now two weeks since the onset of the blood clot in my leg, and I am starting to feel better – less pain, a little less fatigue, and once again on track. I have more tests to come but for now am hoping that things will be quiet for a while.
[Continued in Part 5]