While clinician and patient experience has demonstrated the potential of many treatments offered by naturopathic doctors to reduce adverse events and increase quality of life in cancer patients, they are generally not integrated into modern oncology care, and patients must avail themselves to these complementary therapies in isolation of their traditional therapies. To address this deficit in evidence and collaboration, large-scale, methodologically sound randomized controlled trials of integrative care interventions offered by naturopathic doctors are vitally required.
It is known that more than half of all cancer patients use complementary therapies including massage, acupuncture, vitamins and natural health products (NHPs). Increasingly, there is interest in an integrative program of care that includes both complementary and standard cancer treatments. The goals of an integrative approach to cancer care include reducing symptoms associated with standard cancer treatments, assisting people to endure cytotoxic treatments and surgery, alleviating distress, improving quality of life and preventing cancer recurrence.
The high prevalence of complementary therapy and, in particular, herb and vitamin use among pre-surgical patients presents an interesting challenge. On one hand, several therapies are supported by rigorous evidence to suggest a potential benefit for a range of relevant outcomes, including surgical outcomes, anxiety, mood and time to recovery. On the other hand, several risks have been identified in relation to the use of specific complementary therapies perioperatively. For example use of gingko biloba, garlic, and ginseng has been shown to interfere with platelet function and thus increase the likelihood of bleeding.101 Given that these therapies are among some of the most common NHPs in use by pre-surgical patients, it is thus vital that professional guidance is warranted around their use. The potential for benefit in relation to the potential for harm underlines the need for guidance by qualified practitioners, trained in the specific therapies and their concurrent administration during cancer treatment, including surgery. Naturopathic medicine, a regulated and licensed profession in many of the Canadian provinces, including Ontario and British Columbia, provides rigorous training in the clinical application of complementary and integrative medicine. NDs are considered experts in the use of NHPs and are frequently engaged by people living with cancer who wish to include a complementary integrative approach in their care.
The thoracic surgery research team works together with NDs at The Centre for Health Innovation to create clinical trials designed to test the effectiveness of integrative care through either rigorous randomized controlled trials or real-world, pragmatic research.
Relevant Papers:
- Seely, D., Wu, P., Fritz, H., Kennedy, D. A., Tsui, T., Seely, AJE., & Mills, E. “Melatonin as adjuvant cancer care with and without chemotherapy: a systematic review and meta-analysis of randomized trials.” Integrative cancer therapies 11.4 (2012): 293-303.
- Seely, D., Ennis, J. E., McDonell, E., Fazekas, A., Zhao, L., Asmis, T., … & Seely, AJE. “Intervention Development Process for a Pragmatic Randomized Controlled Trial: The Thoracic Peri-Operative Integrative Surgical Care Evaluation Trial.” The Journal of Alternative and Complementary Medicine 25.S1 (2019): S112-S123.
- Seely, D., Legacy, M., Auer, R. C., Fazekas, A., Delic, E., Anstee, C., … & Seely, A.JE. “Adjuvant melatonin for the prevention of recurrence and mortality following lung cancer resection (AMPLCaRe): A randomized placebo controlled clinical trial.” EClinicalMedicine 33 (2021): 100763.
