The final talk was delivered by Jimmie Holland, MD, Chair, Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center. "Quality-of-Life Issues in CAM: Effect on Research Methodology". She discussed the positive trend among cancer patients to continue conventional therapy and add complementary interventions. These might help and won't hurt but should be discussed more openly with the oncologist. Some patients refuse or stop conventional therapy and were defined as: those with serious psychiatric disorders, fixed beliefs in mind-body cancer connections, irrational fears of treatment (surgery, radiation, chemotherapy) or distrust of conventional medicine/physicians. The patients who use CAM have a "greater perceived belief in personal or other (MD) control over the course of cancer". (S. Taylor, Cognitive Adaptation). In breast cancer patients this means a search for meaning-beliefs about the cause of cancer: stress, hormones, genetic, diet, trauma. Burnstein et al, 1999 found that patients with greater distress use CAM. (See Ann's NOTE above). The new use of CAM during the first year after a diagnosis of breast cancer was a marker for depressive symptoms, fear of recurrence, mental health, sexual satisfaction and physical symptoms. These distressed patients, according to Wargovich et al, 2001 'fear the stigma of psychiatric/psychological care and psychiatric medications so they do not reveal their distress to doctors, CAM is more acceptable. Evidence-based behavioral interventions (relaxation, visual imagery, hypnosis, biofeedback) can improve QOL but do not extend survival. There is a blurring of the evidence-based behavioral interventions with complementary 'mind' therapies. And patients with 'distress' turn to CAM rather than utilize mental health services attached to oncology, which is more stigmatizing and less acceptable. People who use CAM have inadequately controlled symptoms like pain, nausea, fatigue, anxiety and depression. For pain, such patients are using acupuncture, herbs, heat, and massage. They hesitate to discuss their pain (with oncologists) and they fear the 'side' effects of analgesics. (Potter et al, 2002). Methods of 'mind' CAM intervention studies must conform to standards for randomized controlled trials for psychiatric/psychological interventions. Placebo and standard care arms in trials are crucial since the outcome is subjective symptom control or QOL. A double blind study is sometimes difficult with CAM interventions as the therapist cannot be 'blinded'. One recommendation is to 'blind' the patient and the outcome evaluator. (Caspi, 2000) Basic take home for Oncology-"Ask about CAM use". Pay attention to patients' quality of life issues and lifestyle, i.e. diet and exercise. The research agenda must include well designed trials of CAM to determine those that can become evidence-based by either impact on survival or reduction in distress and improved well-being and QOL. "The Philosophies of one age become the absurdities of the next, and the foolishness of yesterday becomes the wisdom of tomorrow". Sir William Osler, Montreal Medical Journal, 1902. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.