Complementary and Alternative Medicine (MAC)
Complementary and Alternative Medicine (MAC) as defined by the National Center for Complementary and Alternative Medicine (NCCAM) is a group of health care systems and practices various and diverse products that are currently not considered to be part of conventional medicine. Standard or conventional medicine is scientific evidence-based care. For her cancer include chemotherapy, radiation therapy, biological therapy and surgery.
Complementary and Alternative Medicine (MAC) often utilizes practices to enhance or complement standard treatments. In general they are not recognized by the medical community as standard or conventional medical modalities. Complementary medicine may include dietary supplements, megadoses of vitamins, herbal preparations, special teas, acupuncture, massage, magnet therapy, spiritual healing and meditation.
Conventional medicine uses now widely accepted treatment for a certain type of disease, based on previous research findings. Conventional medicine is practiced by medical doctor title holders and related professions including physiotherapists, psychologists and nurses (nurses). Other terms for conventional medicine include alternative medicine, orthodox standard medicine, common and biomedicine. Some practitioners of conventional medicine are also practitioners of complementary and alternative medicine.
Complementary medicine is used together with conventional medicine. Alternative medicine is used instead of conventional medicine. MAC is often used for children with cancer both in clinical trials and outside them. MAC has been used to treat the side effects resulting from cancer or cancer treatment.
It is important that CAM therapies to be evaluated with the same long and thorough research process used to evaluate conventional treatments. National Cancer Institute (NCI) and the Office of Cancer Complementary and Alternative Medicine (Occam) is sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer.
A classification system was developed by NCI PDQ editorial for Cancer Treatment in Adults to allow classification of human cancer treatment trials according to the statistical power of the study design and scientific power treatment outcomes (endpoints) measured. This classification system was adopted to allow classification of human studies of complementary and alternative medicine treatments for cancer. The purpose of classification studies in this way is to help readers in assessing the strength of evidence associated with particular treatments. However, not all human studies are classified. Only those who report a therapeutic effect, such as tumor response, improvement in survival or improvement in quality of life are taken into account.
In the classification system a numerical scale from 1 to 4 is used to indicate the statistical power of the study design, with one attributed studies showing the strongest design (design, conception) and 4 studies have attributed the poor design. The different types of study design are described below in order of decreasing power:
1. Randomized controlled trials: Studies in which participants are taking the chance to separate groups of patients for comparing different treatments. It is patient choice to be in a randomized, and neither the patient nor the researcher can choose which group he or she will be placed. Using chance to assign patients helps ensure that groups will be similar and the treatments they receive can be compared objectively. In the time trial (trial), there is uncertainty about which treatment is best. These studies may be “double-blind” or “nonblinded.” Double-blind studies are the strongest design.
-Study Double-blinded: neither the patient nor the researcher did not know which patients receive therapy in the study or control treatment.
– Nonblinded Study: researcher and know what treatment patients receive.
2. Nonrandomized controlled trials: Studies in which participants are assigned to a treatment group based on criteria that can be known by the researcher, such as date of birth of the patient, the number of chart, clinic or day programming. With this type of study design, there is less confidence that the group receiving study treatment and control group comparable.
3. Case series: Studies describing results from a group or set of patients who received the treatment being investigated. These studies were poorly designed, due in part to the absence of a control group.
4. The series of cases the best. From larger series of patients, the study reported only cases that appear to have received treatment.
The power of science to results of a study is determined by the final measured objectives. The classification system, a progressive alphabetical scale is used to indicate the scientific strength of the final targets, with A attributed the stronger endpoint that can be measured and attributed weakest point D ultimate goal. Typically endpoints measured in human cancer treatment trials are listed below in descending order of power:
A. Total mortality: proportion of the population in the study who died. Commonly named death rate. Measured from a defined point in time, such as the time of diagnosis or when initiating therapy. This is most easily defined goal and objective. The reverse total mortality, ie, overall survival could be reported value.
B. Case-specific mortality: Death of a specific cause in the population under study, for example, cancer death compared to death due to side effects of therapy compared with death from other causes. The final objective is more subjective than total mortality. When death from diseases (eg cancer, heart disease, etc.) is the ultimate objective measure, the inverse value, ie, disease-specific survival can be reported instead.
C. Quality of life evaluated carefully: Although a very subjective objective, quality of life is extremely important end point for patients. Power quality of life depends on the validity of assessment instruments (eg questionnaires, psychological tests, etc.) used.
D. Indirect substitutes: These are measures which substitutes outcomes for health, and they are subject to interpretation investigator. In descending order of power, indirect surrogates include:
i. Disease-free survival: The length of time the cancer was not detected after treatment.
ii. Progression-free survival: The time period in which the disease was stable or getting worse after treatment.
iii. Tumor response rate: The percentage of patients whose tumors responded to treatment and the degree or extent to which tumors responded.
To assist readers in evaluating the results of human studies of complementary and alternative medicine treatments (CAM) for cancer, the strength of evidence (eg, “levels out”) associated with each type of treatment is provided whenever possible. To benefit from a level of analysis evident, the study should:
– Be published in a scientific journal.
– Report data on outcome or therapeutic outcomes such as tumor response, improved survival or improve quality of life.
– Describe the clinical data sufficient detail so that they can make a meaningful assessment.
The results of studies on the use of alternative and complementary therapy are inconsistent.
A large study published in the November 11, 1998 in American Medical Association Journal found that CAM use in the general public increased from 33.8% to 42.1% An analysis of data from the National Health Interview Survey from 1999 showed that only 28.9% of American adults (aged ≥ 18 years) had used at least one CAM therapy in the past year. A large study of CAM use in patients with different types of cancer was published in 2000 in Journal of Clinical Oncology. This study found that 69% of 453 patients had used at least one CAM therapy as part of their cancer treatment. In 2007 National Health Interview Survey reported that 4 out of 10 adults use some form of therapy MAC.
A large study on cancer survivors has been reported on the use of complementary therapies. The most commonly used therapies were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31-84% of children with cancer, both in and outside of clinical trials.
Complementary and alternative medicine include:
-acupuncture and herbal products
– spiritual healing and meditation
-therapies by mental-body massage
– nutritional -therapy
• biological and pharmacological treatment
In general therapies and complementary alternative medicine are not recognized by the medical community as standard or conventional medical modalities.