“I would have thought more people would tell their doctors,” says Dr. Nina Sanford on her findings that 29 percent of cancer patients using alternative medicine during treatment don’t disclose its use. Dr. Sanford is an assistant professor of radiation oncology at the University of Texas Southwestern Medical Center, and she is lead author of a study just published (April 2019) in JAMA Oncology.
Despite a high use of Complementary and Alternative Medicine (CAM) among neurology patients, neurologist Sarah Mulukutla, MD, MPH, says, more than half of those patients are not telling their providers. “So what actually is going on, is that we have two separate healthcare models.” We’ve heard this before.
The disconnect between these two models of healthcare (CAM vs allopathic care) means that when physicians are deciding on the best treatment, they are missing half the picture. For cancer patients, who according to the JAMA study seek out CAMs at a higher proportion than others, this can be life threatening. Sanford cites the potentially adverse effects that high levels of antioxidants (in herbal supplements) may have during radiation treatment.
According to Sanford and her team, herbal supplements were the most commonly used CAM in her study, followed by chiropractic or osteopathic manipulation, massage, yoga, and mindfulness/meditation. The latter of these, Sanford acknowledges, may be beneficial in dealing with the stress of cancer treatments.
Sanford’s cross-sectional study involved analysis of data from the Centers for Disease Control and Prevention’s National Health Interview Survey. Of the 3,000 participants reporting a history of cancer, one third (33.3%) reportedly used CAM in the previous 12 months. Of that third, 29.3 percent did not disclose CAM use to their physicians. The most common reasons for non-disclosure were that their physician didn’t ask or they (patients) didn’t think it was relevant. It is over that last finding that physicians may have the most control.
Americans spend about $30 billion out-of-pocket on CAM per year, and that appears to be growing. With this level of buy-in, it’s safe to say that CAM isn’t going anywhere, so to improve transparency and patient safety, it’s up to physicians to initiate a dialogue about it. Mulukutla and other members of the American Academy of Neurology’s (AAN) Section on Neurohealth & Integrative Neurology are trying to help neurologists do just that.
“Integrative Neurology is a group of physicians that are looking at the evidence base for various types of complementary therapies,” said Mulukutla at last year’s annual AAN meeting. The academy offered a CME-accredited course on integrative neurology at their 2018 annual meeting, and they are offering the course again this year. “The first step,” says Mulukutla, “is actually changing the dialogue from a disease-based model to a health-focused conversation.”
Shifting the discussion toward wellness may encourage more discussion about alternative treatments. It is also an opportunity to remind patients that you share their goal of achieving optimal health, and that all their pursuits toward that goal (including CAMs) are relevant to discuss with you. Let the non-disclosure rates in the JAMA study be a reminder that what may seem obvious to you may not be to your patients.