Legal and Ethical Use of Complementary and Alternative Medicine Interventions in Oncology

A dangerous trend is emerging to force physicians to provide unproven drugs to patients with COVID-19. It could spill over into oncology.

Posted: 10/31/2022 12:39:00 PM

Last Updated: 10/31/2022 1:47:35 PM

In addition to, or instead of, receiving therapies that are the standard of care, patients with cancer sometimes request to receive complementary (therapies used in conjunction with standard cancer treatment) and alternative (nonstandard treatments used in place of standard cancer treatment) medical treatments, despite limited evidence of their efficacy. Some examples of complementary and alternative therapies include mind/body practices (such as meditation and yoga); biologically based practices (such as dietary and herbal supplements and cannabis); manipulative and body-based practices (such as massage, chiropractic therapy, and reflexology); biofield therapy (such as Reiki and therapeutic touch); and treatments from traditional medical systems (such as ayurvedic or traditional Chinese medicine).1

In this column, I discuss the ethical and legal issues presented by patient requests to include complementary and alternative medicine in their cancer treatment plan.

Govind Persad, JD, PhD

Govind Persad, JD, PhD

The Allure of Complementary and Alternative Medicine

Despite research showing that patients with cancer who solely use alternative therapies instead of standard cancer treatments have much higher mortality rates, nearly 40% of Americans surveyed by ASCO believe cancer can be cured solely through alternative medicine.2 Cancer is a disease that poses particularly fertile ground for complementary and alternative medicine requests from patients. For some cancers, existing treatments may not offer high expectations of cure or multiyear survival, making complementary and alternative medicine therapies particularly attractive to patients. And treatments for cancer usually carry burdensome side effects that patients want to avoid, including financial toxicity.

Some complementary methods, such as prayer, spirituality, and mind/body practices, can easily coexist with recommended cancer interventions, presenting few ethical and legal problems. These interventions, even when they have not been proven to benefit patients, are unlikely to interfere directly with cancer treatments or present other risks of medical harm.

Nearly 40% of Americans surveyed by ASCO believe cancer can be cured solely through alternative medicine.

— Govind Persad, JD, PhD

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Other complementary and alternative treatments, such as dietary supplements and herbal medicines, can also often coexist with recommended cancer interventions, but they present greater potential for conflict. Some potential conflicts involve interactions between these biologically active medicines and standard cancer therapies, which may interfere with the effectiveness of cancer therapies, and patient refusal to receive surgery, radiation, chemotherapy, or other traditional treatment because they believe complementary and alternative medicine therapies alone will cure them.

Although competent adults always have the ethical and legal right to refuse recommended treatments, often clinicians can work with patients to offer information that may mitigate these conflicts. For example, oncologists may suggest complementary practices that do not pose a risk of harmful drug interactions and that help patients cope with the side effects of cancer and its treatment, including nausea, pain, and fatigue.

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