Positive Health Online

Richard Eaton explores the contribution by practitioners of Complementary and Alternative Medicine (CAM) to the provision of cancer healthcare in the United Kingdom (UK). Although this article focuses on the contribution by CAM practitioners to cancer healthcare, it could be read in conjunction with my previous article titled The UK National Health Service should Engage with Complementary and Alternative Medicine published in Issue 248 (August 2018) of PH Online.

Practitioners are frequently called upon to provide a therapy to relieve the symptoms of cancer or the side-effects of treatment prescribed by a Consultant/Oncologist, sometimes as part of an integrated (possibly palliative care) treatment plan, through which the patient aims to receive the best of CAM and orthodox medicine, or to provide such relief where no further orthodox medical treatments are either available to or desired by the patient.

These practitioners will be aware that it is a criminal offence to take part in the publication of advertising of advice, treatments or remedies to a person who is either suffering, or suspected to be suffering, from cancer (see: Sections 4 and 5(2), Cancer Act 1939).

Cancer has been described [1] as:

“…a diverse class of diseases characterized by uncontrolled cell growth that constitutes the greatest cause of mortality and morbidity worldwide. Despite steady progress, the treatment modalities of cancer are still insufficient…”

Sections 4 (1) and 5 (2) of the Cancer Act 1939 [2] provide, among other things, that:

“…4 (1) No person shall take any part in the publication of any advertisement – (a) containing an offer to treat any person for cancer, or to prescribe any remedy therefore, or to give any advice in connection with the treatment thereof…’ [and further that] ‘…(8) In this section the expression “advertisement” includes any notice, circular, label, wrapper or other document, and any announcement made orally or by any means of producing or transmitting sounds…”

“…5 (2) In this Act references to persons suffering from cancer shall be construed as including references to persons suspected to be so suffering…”

This article does not constitute legal, medical or other advice. If you are in any doubt about how this (or any other) legislation may affect you or your practice, I recommend that you seek the advice of a legal professional. Practitioners should also obtain any guidance and advice that is available from their professional membership organisation and regulator.

It is well known that practitioners of CAM perform an immensely valuable professional healthcare role when practising in public (including NHS) and private sector surgeries, clinics, medical centres, cancer centres, hospital oncology departments, hospices and palliative care centres, often on a voluntary basis and following referral by a General Medical Practitioner (GP), a Hospital Consultant or other health professional.

In its February 2016 Newsupdate (issue 76) [3] The Complementary and Natural Healthcare Council (CNHC), stated that its response to the (then) National Institute of Care Excellence (NICE) proposal to remove complementary therapies from supportive and palliative guidelines included the following key points:

“…The provision of complementary therapies is demanded by patients hence the services provided. Approximately 40% of breast and prostate patients use complementary therapies and 20% of patients with other cancers. The evidence and audits are very patient-centred and almost always supportive of the service and what it has to offer. Complementary therapies are provided for patients, service users, carers and family members in almost every cancer and palliative care service in the country. Some of the most renowned cancer and palliative centres such as the Royal Marsden NHS Foundation Trust, Guy’s and St Thomas’s NHS Foundation Trust, St George’s University Hospital NHS Foundation Trust, the Christie NHS Foundation Trust and a wide range of hospices and Macmillan cancer centres provide complementary therapies as an integral part of their supportive and palliative care services…Complementary Therapies are now so embedded in the culture of cancer and palliative care that without proper guidance the door will be left open for ad hoc and unsafe practice, without reference to an evidence base. This would be a retrograde step and impinge on patient care and safe practice…”

The CNHC further acknowledges the contribution by complementary health practitioners, particularly in the cancer and palliative care sector, in its response to the Charity Commission Consultation (2017) [4].

In March 2004, the (then called) National Institute for Clinical Excellence (NICE) published information  [5] and a guidance manual on cancer services titled Improving Supportive and Palliative Care for Adults with Cancer, [6], section 11 of which (pages 148 to 154) provides guidance on the use of ‘complementary therapy services’.

The (now renamed) National Institute for Health and Care Excellence has posted project information (publication date: To be confirmed) under the heading End of life care for adults in the last year of life: service delivery .[7] By the time this article is available, it is anticipated that an updated NICE publication will include recommendations for the continued use of complementary healthcare.

The Royal Marsden NHS Foundation Trust [8] London, in its patient information publication Your guide to support, practical help and complementary therapies [9] (page 7), defines integrated care, as follows:

“…Integrated care’ refers to complementary therapies which run alongside the standard medical care that you receive, either as an inpatient or an outpatient. It aims to take into account all your individual needs, and treats you as a whole person. Complementary therapies may include treatments such as acupuncture, massage therapy, reflexology and relaxation techniques. We encourage you to discuss with your medical team any complementary therapies you are having, or thinking of having, either from The Royal Marsden or from elsewhere. Some herbal and vitamin supplements interact with the drug treatment you may be receiving. The Trust therefore encourages patients and healthcare professionals to communicate with Medicines Information, Pharmacy and/or the Department of Nutrition and Dietetics, respectively, about using any herbs, homeopathic preparations, supplements, vitamins, minerals or exclusion diets. This is so that you can make an informed decision, particularly while you are having any form of active treatment for cancer…”

The above supports the appropriate, safe and cost-effective contribution by CAM Practitioners for relieving the symptoms of cancer and the side effects of cancer treatment.

CAM practitioners know that they should advise patients to inform their GP, Medical Consultant or other health professional that they are using CAM, whether in relation to cancer or any other health condition.

The renowned registered charity Macmillan Cancer Support  [10] has, for some years, published its online guide titled Cancer and Complementary Therapies[11] (cited as at January 2018). Macmillan describes its January 2017, 9th edition (MAC11645) guide as being:

“…A realistic and balanced guide to the complementary therapies used by people living with cancer. These include mind therapies, physical therapies, acupuncture, complementary medicines, alternative therapies and psychological and self-help therapies. Also includes a list of relevant organisations and resources…”

On page 86 of the print version of that edition, it lists a sample of the sources used in the publication, namely:

Garcia MK et al. Systematic Review of Acupuncture in Cancer care: A Synthesis of the Evidence. Journal of Clinical Oncology, 2013; 31(7): 952-960;

Kassab S et al. Homeopathic medicines for the adverse effects of cancer treatments (Review): The Cochrane Library. 2010: Issue (11), to which I refer in more detail below;

Lesi G et al. Acupunctire As an Integrative Approach for the Treatment of Hot Flushes in Women With Breast Cancer: A Prospective Multicenter Randomised Controlled Trial (AcCliMaT). Journal of Clinical Oncology. 2016; 34 (15): 1795-1802.

The Guide is due to be reviewed in 2019. Further Macmillan guidance on Complementary Therapies may be viewed here.[12]

In view of this excellent publication, its invaluable other work and its charitable status, it is immensely regrettable that Macmillan did not respond to the 2017 Charity Commission Consultation on Complementary Medicine.[13]

For evidence where the NHS has both employed CAM practitioners and included them in a NHS hospital Multidisciplinary Team (MDT), refer to the article Shining Example by Jane Sheehan MFHT published in the Summer 2018 edition of International Therapist Magazine (pages 28 to 31: https://www.fht.org.uk/system/files/field/article-files/it_summer_18_28-31_nhs_palliative.pdf ) in which the author writes about establishing a new delivery model for a complementary therapy service within an NHS palliative care unit. She states as follows:

“…This decision by senior management to employ therapists brought about a huge change in the structure of the complementary therapy service. I had not anticipated the length of time that it can sometimes take to achieve such goals, but eventually the model was adopted where the therapists are still paid for by the support group but employed by the NHS, which means that they are fully integrated into the multidisciplinary team providing care for patients in this palliative care setting…”

Earlier in her article, the author writes:

“…A complementary therapy policy was developed to formalise its delivery. It ensures a consistent approach to provide safe and effective complementary therapy for anyone using it with this client group and is based on the National Institute and Care Excellence (NICE) and the Prince of Wales Foundation for Integrated Health national guidelines…”

The NICE guidelines that Jane Sheehan refers to are those dated 2004 on improving supportive and palliative care for adults with cancer. The Prince of Wales’s Foundation for Integrated Health National Guidelines for the Use of Complementary Therapies in Supportive and Palliative Care (May 2003) may be accessed on the SCRIBD subscription website.

I’m grateful to Jane Sheehan and to the Editor of International Therapist Magazine, Karen Young, for permitting me to share the article Shining Example with readers.

As stated in this article, there are a number of CAM treatment modalities that contribute to relieving the symptoms of cancer and the side-affects of conventional cancer treatments. Because homeopathy is particularly under scrutiny at the moment, I refer to the following homeopathy research papers and articles:

1. A randomised, controlled clinical trail of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation (Oberbaum M, Yaniv I, Ben-Gal Y, Stein J, Ben-Zvi, Freedman L S, Branski D; https://www.ncbi.nlm.nih.gov/pubmed/11505416/): This study indicated that TRAUMEEL S might significantly reduce the duration and the severity of chemotherapy-induced stomatitis in children who are undergoing the transplant of bone marrow;
2. A pilot, randomised, double-blinded, placebo-controlled trial of individualized homeopathy for symptoms of estrogen withdrawal in breast-cancer survivors (Thompson EA, Montgomery A, Douglas D, Reilly D; https://www.ncbi.nlm.nih.gov/pubmed/15750359/): “…Improvements were seen for symptom scores over the study period. However, presuming these improvements were caused by the individualized homeopathic approach, the study failed to show clearly that the specific effect of the remedy added further to the nonspecific effects of the consultation. Future trial design must ensure adequate power to account for the nonspecific impact of such complex individualized interventions while pragmatic designs may more readily answer questions of clinical and cost effectiveness…”;
3. Homeopathy for menopausal symptoms in breast cancer survivors: a preliminary randomized controlled trial (Jacobs J, Herman P, Heron K, Olsen S, Vaughters L; https://www.ncbi.nlm.nih.gov/pubmed/15750360/): “…Small sample size precludes definitive answers, but results from this preliminary trial suggest that homeopathy may be of value in the treatment of menopausal symptoms and improving quality of life, especially in those women not on tamoxifen. Larger studies should be carried out that also include healthy women who want to avoid hormone replacement therapy…;”
4. Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial (Balzarini A, Felisi, Martini A, De Conno F; https://www.ncbi.nlm.nih.gov/pubmed/10703904/): “…The differences of the scores of the Index of Total Severity during Radiotherapy were not statistically significant, but showed a trend towards a better activity of the homoeopathic medicine compared to placebo. Analysis of the data on Total Severity during recovery, showed a statistically significant benefit of the active medicines over placebo. The homeopathic medicines had particular effectiveness on the heat of the skin. The limited number of patients observed and the posology employed could have interfered with the significance of the results. Chemotherapy and hormonotherapy do not seem to affect the results…”;
5. Phase 111 randomised trial of Calendula officinalis compared with treatment for the prevention of acute dermatitis during irradiation for breast cancer (Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X; https://www.ncbi.nlm.nih.gov/pubmed/15084618): ‘…Calendula is highly effective for the prevention of acute dermatitis of grade 2 or higher and should be proposed for patients undergoing postoperative irradiation for breast cancer…’;
6. Can homeopathic treatment slow prostate cancer growth? (Jonas WB, Gaddipati JP, Rajeshkumar, Shama A, Thangapazham,RL, Warren J, Singh AK,, Ives JA, Olsen C, Mog SR, Maheshwari RK; https://www.ncbi.nlm.nih.gov/pubmed/17101763): ‘…The findings indicate that selected homeopathic remedies for the present study have no direct cellular anticancer effects but appear to significantly slow the progression of cancer and reduce cancer incidence and mortality in Copenhagen rats injected with MAT-LyLu prostate cancer cells…’;
7. Homeopathic medicines for adverse effects of cancer treatments (Sosie Kassab, Mike Cummings, Saul Berkovitz, Robert van Haselen, Peter Fisher; https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004845.pub2/full): Reviewed the above, together with other research, and acknowledged that patients frequently use homeopathic medicines alongside conventional medicines to mitigate side effects. The review reported data supporting efficacy of topical calendula for prophylaxis in relation to acute dermatitis during radiotherapy and also of Traumeel S mouthwash for the treatment of chemotherapy‐induced stomatitis. It further concluded that these trials needed replicating and that there was no evidence (which was convincing) regarding homeopathic medicines’ efficacy for other adverse effects of cancer treatments.

The following brief articles may also be of interest:

(a). https://homeopathyplus.com/homeopathy-for-radiotherapy-and-chemotherapy-side-effects/ includes a caution that, where there has been radiotherapy or chemotherapy treatment, homeopathic remedies should only be used after (i.e. following) such treatment to combat its side-effects, rather than ahead of (i.e. to prevent) the side-effects of these treatments occurring;

(b). https://homeopathyplus.com/preparing-for-radiation-homeopathic-remedies-that-protect-against-x-rays-ct-scans-and-other-radiological-procedures/ explores, among other things, homeopathic remedies (Cadmium sulphuricum or homeopathic X-ray) being prescribed to mitigate the effects of radiation exposure from scans (e.g. x-rays, CT and fluoroscopy). It cites the article in the New England Journal of Medicine (2007): Computed Tomography – An Increasing Source of Radiation Exposure by David J. Brenner, Ph.D., DSc., and Eric J. Hall, D.Phil., D.Sc. (https://www.nejm.org/doi/full/10.1056/NEJMra072149).

Practising homeopaths will, no doubt, exercise their professional judgement with regard to the research papers and articles referred to above.

The modality of Healing is also being applied in cancer care. In the final paragraph of my previous article, The UK National Health Service should Engage with Complementary and Alternative Medicine, I refer to the book by Angie Buxton-King titled The NHS Healer: Onwards and Upwards (2018; Amazon paperback; Vanguard Press ISBN 978 1 784653 11 8). Angie was employed by University College, London (UCLH) as a healer from 1999 to 2011.

In the context of this article, relating to CAM and cancer, it is appropriate to refer again to the endorsement of Angie’s book by Stephen Rowley, Senior Divisional Nurse Clinical Haematology UCLH, from which I quote as follows:

“…Seeing doctors ask for a healer to help support a patient through a medical procedure was not unusual and at the time represented a quiet but important evolution in cancer care. Over the subsequent decade, the supportive and clinical benefits that healing provides has provided the evidence and assurance for healing to be delivered alongside conventional treatments on a wider scale. The further expansion of well governed healing into 13 other centres via the SBSHT is further tangible evidence of the role healing is playing in the integrated care of patients.”

[Note: ‘SBHT’ refers to http://www.cancertherapies.org.uk].

With reference to Clinical Aromatherapy, practitioners of this therapy will be interested in the publication of the (October 2017) pilot study titled: Aroma oil therapy in palliative care: a pilot study with physiological parameters in conscious as well as unconscious patients[ https://www.ncbi.nlm.nih.gov/pubmed/28634728], which concluded:

“…Significant physiological reactions were measured after simulation with aroma oils in all three groups in this study. Healthy probands showed different reactions than palliative patients irrespective to their conscious state…”

An article about this study may be found here [34].

There are countless research papers, articles and organisations that focus on cancer-care.

Here are some preliminary sources:

Europe PMC [14];

PubMed: US National Library of Medicine, National Institutes of Health (search “Cancer”) [15];

American Journal of Cancer Research [16];

Cochrane Library (search “cancer”) [17];

Cancer Research UK [18];

http://www.cancerresearchuk.org/our-research [19];

Positive Health Online, Research pages (Cancer) [20];

Research Council for Complementary Medicine (RCCM) [21];

https://www.evidence.nhs.uk/ (search: “cancer-complementary medicine”) [22];

European Association for Cancer Research (EACR) [23];

The Institute of Cancer Research [24];

Worldwide Cancer Research [25];

Rare Cancers Europe.[26]

An editorial by the Carstens Foundation summarises an approach that could also be adopted by UK NHS and private sector hospitals aiming to provide their patients with CAM and to initiate CAM research, when it reports about courses provided by The Ev. Hospital Hamm:

“…The Ev. Hospital Hamm (EVK) has been striving to treat its patients with a holistic approach for almost two decades. Thus, art therapists, psychoanalysts and pastoralists are integrated as well as the Institute for Traditional Chinese Medicine with its integrative treatment concepts.

For the inpatient and outpatient patients of the EVK, as well as for external patients, the offer of integrative modules is expanded. With different group therapies the mental stability is to be improved, the side effects are relieved and the inner power sources of the patients are opened up…”

Course programme, dates and contact details can be found on the carstens-stiftung website here [27].

An example of a complementary medicine academic research initiative is the University of Heidelberg implementing a new doctoral dissertation titled Enlightenment of molecular mechanisms of action as the basis for an evidence-based complementary and integrative medicine, set up by means of Baden-Württemberg's state doctorate program (LGF) as 4 Promotional Fellowships[28] with a funding period of three years beginning on 1 October 2017 or possibly later. Also view details here [29] and the announcement: 4 Postdoctoral positions in Naturopathy and Complementary Medicine: Carstens Foundation provides up to 1.2 million euros for science and research.[30] 

For updates on these CAM research and course initiatives (and much more) you can subscribe to the free, monthly Karl and Veronica Carstens Foundation Newsletter (for which an English translation is available) here [31].

On 24.11.17, the Alliance for Natural Health International (ANH-Intl) [32] issued a press release under the caption Personalised Medicine offers new hope for pancreatic cancer patients referring to a paper published in the peer-reviewed journal Integrative Molecular Medicine titled Scientific rationale for integrative and personalised strategies for pancreatic ductal adenocarcinoma management, a review article (Peyda Korhan, Robert Verkerk and William R Critchley) which may be viewed here [33]. The press release describes it as follows:

“…The near exhaustive review article, which evaluates the multitude of genetic and environmental factors that influence pancreatic cancer, including a diverse range of emerging treatment options, is the result of a two-year collaboration between the Neuroscience Solutions to Cancer Research Group at Imperial College London and a non-profit active in the field of healthcare sustainability, the Alliance for Natural Health (ANH) International…”

Here is an extract from the paper sub-headed Potential application of integrative oncology for achieving optimal outcome and maximal QOL [i.e. Quality of Life]:

“…Furthermore, the decrease in functional status and increase in disability that result from cancer and its treatment greatly affect the QOL of cancer survivors. Research has shown that evidence-based complementary approaches used in conjugation with standard medical treatments may help to facilitate health during both active oncology treatment and survivorship [267,268]. Complementary therapies include massage therapy, acupuncture, mind-body therapies, music therapy, physical exercise and nutrition and nutritional supplements and other modalities [269,270] Integrative Oncology serves to optimally combine conventional therapies and the best complementary therapies to positive influence outcomes and improve quality of life, whether or not a person is near the end of his or her life [265-268]. With the evolution of personalised cancer care and growing evidence to support the efficacy of multi-factorial, integrative therapies, personalised treatment plans might be more likely than conventional treatments on their own to meet the patients’ needs, while also helping to improve survival and QOL of people affected by cancer. The application of biomarkers to clinical practice may not only facilitate the design of personalised therapies and better predict clinical outcomes, but also provide information to improve survival and QOL. Biomarkers that are modifiable by physical activity, diet, stress and environmental factors may be useful to help plan personalised lifestyles and to monitor responses to interventions. For instance, relevant biomarkers for the observed associations among physical activity, overweight or obesity, and cancer are sex steroid hormones, hyperinsulinemia and insulin resistance, metabolic hormones, increased inflammation, depressed immune function, and oxidative stress [271]…”

The review article concludes, among other things, that:

“…Considering the limitations of current conventional chemotherapeutics, including serious toxicities and reduced QOL for cancer patients, the development of safe and efficacious supplementary or alternative interventions such as natural products with known/predictable mechanism of action seems to promote therapeutic efficacy while improving QOL.  Further preclinical research followed by carefully designed clinical trials is highly necessary to accelerate the development of novel strategies offering best treatment to each patient. Personalised Medicine approach with lifestyle recommendations based on biomarkers may provide a novel means of assessing a PDAC [Pancreatic Ductal Adenocarcinoma] patient’s health by empowering them with information they need to regain control of their life. It is hoped that incorporation of some of these approaches will go some way to improving QOL and survival for individuals with this devastating disease…”

Understandably, the media will eagerly report on any research that it perceives might have answers relevant to the treatment of cancer.

This was the case with a biomedical engineering research proposal [35] by the Arizona College of Engineering (University of Arizona)[36] that was of interest to many CAM practitioners as it explored the medical properties of a non-toxic substance, baking soda. It appeared as a university news item (30.03.12) on UANews [37] titled:

“…Grant to Fuel Baking Soda Cancer Therapy Research: Drinking baking soda has been proven to reduce or eliminate the spread of breast cancer to the lungs, brain and bone, but too much of it can damage normal organs…”

My enquiries into the outcome of this research confirmed that it primarily focused on methods that measure tumour acidosis. The researchers tested baking soda to show that they could measure a change in pH in acidic tumours. It did not test baking soda as a treatment. The media, especially news outlets beyond the University of Arizona, picked up this story and morphed it to be more about treatment than diagnosis.

The Moffitt Cancer Center [38] tested baking soda as a treatment. However, the clinical study was quickly suspended because patients could not drink enough baking soda to maintain a change in tumour pH. It was very unpleasant to drink in high concentrations so could not be recommended as a practical treatment.

Resveratrol has, for many years, been of interest to CAM practitioners as a natural, plant-based, new concept, anti-cancer agent with chemo-preventive properties. Here are some links to research papers and articles:

Effects of resveratrol on drug – and carcinogen – metabolizing enzymes, implications for cancer prevention (2017) [39]:

“…This review summarizes the known effects of resveratrol and its main metabolites on drug metabolism in order to help characterize which populations might benefit from resveratrol for the prevention of cancer, as well as those that may need to avoid supplementation due to potential drug interactions…”; 

Resveratrol modulates drug – and carcinogen – metabolizing enzymes in a healthy volunteer study (2010) [40]:

“…We conclude that resveratrol can modulate enzyme systems involved in carcinogen activation and detoxification, which may be one mechanism by which resveratrol inhibits carcinogenesis. However, pharmacologic doses of resveratrol could potentially lead to increased adverse drug reactions or altered drug efficacy due to inhibition or induction of certain CYPs. Further clinical development of resveratrol for cancer prevention should consider evaluation of lower doses of resveratrol to minimize adverse metabolic drug interactions…”; 

Lung carcinogenesis: resveratrol modulates the expression of genes involved in the metabolism of PAH in human bronchial epithelial cells (2001) [41]:

“…These data indicate that resveratrol may exert lung cancer chemopreventive activity through altering the expression of genes involved in the metabolism of polycyclic aromatic hydrocarbons, resulting in altered formation of carcinogenic benzo[a]pyrene metabolites in human bronchial epithelial cells…”;

A Comprehensive Review on the Chemotheraputic Potential for Cancer Treatment, with Mechanistic Insights (2016) [42]:

“…Many studies have reported the remarkable and significant properties of dietary plant polyphenols such as curcumin, resveratrol, flavopiridol, indirubin, magnolol, piceatannol, parthenolide, epigallocatechin gallate, and cucurbitacin as anticancer agents known for their pleiotropic effects on cancer, immune cells, and inflammation. Piceatannol, an analogue and metabolite of resveratrol, is a natural stilbene commonly found in grape skins and wine…This comprehensive review summarizes the current data regarding the mechanisms of action of piceatannol, its chemopreventive properties, and its possible therapeutic potential against various types of human cancer…”

Links to policy statements about UK Government and NHS (including participation by hospitals) cancer research may be found here [43] and here[44].

A significant number of NHS professionals hold qualifications in one or more complementary therapies which they are willing to practise in the best interests of their patients. So it is reasonable to ask the question: Is their potential being made use of within the NHS? Sadly and frustratingly, I suggest the answer to this must be “No”.

Writing on the College of Medicine [45] website (Nurses are vital to progressive, integrated healthcare – because they have the trust of patients) [46], Professor Dame Donna Kinnair opines:

“…Nurses and midwives are in a unique position to ensure that every patient is able to access holistic care…For many of our patients, traditional medicines or clinical interventions are complemented by the use of a variety of herbal remedies, nutrition, acupuncture, mindfulness practices and yoga to name but a few…”

The practise of CAM, including for the purposes of providing cancer care, by appropriately qualified nursing and midwifery NHS staff should be encouraged by the Royal College of Nursing [47] and the Nursing and Midwifery Council [48] (the nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland) and, where necessary, recommended in guidelines issued by the National Institute for Health and Care Excellence. For a more detailed argument presenting the case for this, please refer to my previous article The UK National Health Service should Engage with Complementary and Alternative Medicine.

Furthermore, one way of recruiting and retaining NHS staff would be to recognize, reward and make full use of their hard-earned and properly regulated complementary therapy skills. This would enhance patient care and, arguably, reduce the pressure on GP appointments. With one in five doctors, according to a survey of 900 doctors by the GP magazine Pulse [49], doing more than 50 consultations a day, twice the number recommended under European safety guidance, the adoption of CAM must be sensible strategy?

There is, worldwide, the highest regard, admiration and respect for the objectives of the UK NHS and for the exemplary work of its staff, often undertaken under very difficult conditions. Writing in the Sunday Times newspaper on 15.10.17, Cally Palmer, National Cancer Director of NHS England, commented on the study (EC Schneider, DO Sarnak, D Squires, A Shah & MM Doty) by the Commonwealth Fund [50], which states:

“…an independent health policy foundation based in New York, published its latest report comparing healthcare systems in 11 developed economies. The UK ranked first in performance overall and America came last…survival rates in the UK after diagnosis have never been higher…it is vital patients know of the progress made in Britain so they continue to have confidence in the NHS”

Practitioners of CAM will have contributed to this outcome so far as they were permitted to do so, for instance while working at the leading NHS Foundation Trust Hospitals identified by The Complementary and Natural Healthcare Council in its February 2016 News Update [51] (see above).

Initiatives promoting an integrative approach to cancer care include Yes to Life [52] that defines its aims as follows:

“…We want to change attitudes and make integrative cancer care (combining the best of conventional and complementary approaches) readily available so more people have the best chance of reclaiming their health. We provide support, information and financial assistance to those with cancer seeking to pursue approaches that are currently unavailable on the NHS…” 

Yes to Life is supported by a strong team of expert, integrative medical advisers [53] that includes Dr Michael Dixon, Chairman of The College of Medicine [54].

As organiser of the event (which has ended) called Starting the Conversation [55], that explored ways in which integrating conventional cancer care and lifestyle medicine can improve outcomes, Yes to Life facilitated a Conference on 25^th November 2017 which presented the following Headline Speakers: Dr Rangan Chatterjee, Dr Rupy Aujla, Professor Robert Thomas, Dr Malcolm Kendrick and Sophie Sabbage together with other confirmed speakers, namely Robert Verkerk (Alliance of Natural health), Claudia Manchanda (Herbalist), Liz Butler (Body Soul Nutrition), Lizzy Davies (CanExercise), Justin Price (Regenerus: functional testing), Mark Boscher (Herts MS Therapy Centre), Dr Damien Downing (British Society for Integrative Oncology) and Catherine Zollman (Penny Brohn UK).

I list their names to demonstrate the diversity and expertise of those supporting this important integrative health initiative.

For details of another integrated health proposal that presents a case for exploring natural health cancer care, refer to the research proposal launched by Dr Sandra Goodman, titled Cancer Patients’ Survival: Comparing Integrated Alternative Therapies and Chemotherapy/Radiotherapy Treatment [56] which deserves the support of all health professionals (CAM and conventional) and their patients.

A selection of literature reviews and articles relating to cancer, edited by Dr Goodman, may be viewed here [57] and here [58].

As healthcare professionals, it is to be expected that cancer-care practitioners, academics and researchers will consider it their professional duty to analyse, understand and properly determine the clinical effectiveness of natural cancer treatments and that they should also acknowledge the extent to which non-toxic cancer treatment approaches are important to many patients, including to those who feel they have been abandoned by orthodox oncology.

To this end, they could start by reading the article The Suppression of a Natural Cancer Cure [59] by Ty Bollinger [60] before going on to read his book The Truth about Cancer (ISBN 978-1-4019-5223-5, published by Hay House in 2016) which has been reviewed here [61], as follows:

“…This is perhaps the most comprehensive, intelligible and well-researched book I have read in a long time which examines the political / historical / financial cancer saga, the dire consequences of most conventional treatments, as well as an in-depth elucidation of a myriad of non-toxic and clinically effective cancer treatment approaches…” 

There is an urgent need for practitioners, their representatives and patients to engage with reputable healthcare organisations and to lobby them to research and analyse the existing and potential contribution by CAM to UK cancer healthcare. Such organisations could include:

The NHS Confederation [62] which describes itself as “the authentic voice of NHS leadership” and as “the only membership body that brings together, and speaks on behalf of, the whole health and care system”;

The Nuffield Trust [63], “an independent health charity which aims to improve the quality of health care in the UK by providing evidenced-based research and policy analysis and informing and generating debate”;

The National Association of Primary Care [64], a national membership organisation representing and supporting the interests of all healthcare professionals, both clinicians and managers, working across the breadth of primary care. The organisation is at the centre of shaping the future of healthcare, spreading innovation, influencing policy, supporting and connecting professionals – enabling you to provide world-class sustainable patient-centred healthcare”;

Better Value Healthcare [65] which has a mission to “help health professionals and organisations achieve better health outcomes for individuals and populations, without using more money”;

NHS Improvement [66] supports foundation trusts and NHS trusts to give patients consistently safe, high quality, compassionate care within the local health systems that are financially sustainable;

National Voices [67]: “a coalition of health and social care charities in England that stands for people being in control of their health and care”;

Health watch [68], which describes its mission as: “independent national champion for people who use health and social care services. We’re here to make sure that those running services, and the government, put people at the heart of care”;

The King’s Fund [69] an independent charity working to improve health and care in England;

The Health Foundation [70] an “independent charity committed to bringing about better health and health care for people in the UK.

It may be assumed that the aspirations pursued by these organisations accord with the overall objective of those practising CAM, which is, to quote from the (sadly now obsolete) Royal College of Nursing printed paper guidance publication titled Complementary therapies in nursing, midwifery and health visiting practice: RCN guidance on integrating complementary therapies into clinical care (Publication code 002 204: October 2003) about:

“Putting patients’ best interests first.”

Healthcare organisations, including those listed above, should actively engage with CAM. The NHS is enduring a funding and recruitment crises, particularly in primary care. Everyone engaged in the health and social care sector needs to properly recognise the existing and potential contribution to the provision of cancer healthcare by CAM practitioners. This article together with my previous article, The UK National Health Service should Engage with Complementary and Alternative Medicine, attempt to prove this need.

To appreciate the ‘untapped’ potential of CAM practitioners, refer to the following publication jointly published in November 2017 by The Professional Standards Authority [71] and the Royal Society for Public Health [72]. This report, which may be viewed here [73], confirms (pages 6 & 7) that there are 20,680 Complementary Therapy practitioners listed on accredited registers working across the UK.

Included in the 15 most common occupations among respondents to an accredited registers workforce survey were: Reiki, Reflexology, Aromatherapy, Healing, Massage Therapy and Hypnotherapy. Other CAM practitioners are listed in a ‘breakdown of survey response by profession’ (page 30), as including: Acupuncture, Bowen Therapy, Yoga, Kinesiology, Naturopathy, CranioSacral Therapy, Shiatsu, Alexander Technique and Homeopathy.

The Report recognizes that CAM practitioners are available to promote public health.

More generally, the report concludes (page 27) with regard to Complementary Therapy practitioners and other members (e.g. covering health sciences, talking therapies and physical therapies) of the accredited registers (AR) workforce, that:

“…Practitioners on accredited registers make a large contribution to promoting the public’s health, and this report has drawn out some of the many ways they encourage and promote healthy behaviour and lifestyles in the UK. It is a key principle of the wider public health workforce that every contact between a professional and a member of the public can and should be capitalised upon in any number of ways to support their health and wellbeing. Despite this, it is clear that the large majority of AR practitioners consider themselves to be under-utilised in promoting the public’s health. Meeting the challenges outlined in this report will require the best practice in brief interventions, such as healthy conversations and accurate signposting advice, to be embedded more systematically in the AR workforce. Combined with the significant appetite among accredited registers to play a larger role in supporting the public’s health, the impact of these interventions can be extended as much as possible. With 80,000 practitioners now on accredited registers, many of   whom naturally engage their clients in lifestyle discussions as part of their work already, this workforce should be recognised as an untapped resource, that has both the opportunity and ability to positively impact the public’s health…”

CAM training organisations prepare practitioners to treat patients diagnosed with cancer. The summer of 2018 heralded the launch of the NHS Natural Health School which describes its mission as:

“…to provide complementary therapy diplomas and CPD courses that will uniquely include practical placements and clinical supervision within the NHS. An emphasis on training within the clinical environment will lead to a generation of highly skilled and confident practitioners able to offer a range of therapies to an increasingly complex population…”

The School offers a wide range of approved and accredited courses taught by highly qualified and clinically skilled lecturers who are experienced in working clinically within NHS healthcare settings and providing complementary therapy treatments for patients with a cancer diagnosis.

Courses include clinical placements across hospital and community health settings.

Details of course provision, which includes a NHS Certificate in Complementary Therapies that incorporates 100 hours of clinical practice, tutorials and clinical supervision, may be viewed here.

The School is part of The Sir Robert Ogden Macmillan Centre (SROMC) which provides a number of support services including the SROMC Complementary Therapy Service that, following referral by their healthcare professional, offers a range of complementary therapies (including Reiki, Reflexology, Acupuncture, Bowen Technique, Therapeutic Massage Therapy, Daoyin and Emmett therapy) to patients and their relatives and carers living in the Harrogate and Rural District area who have been affected by a cancer diagnosis.

The SROMC Complementary Therapy Service is funded through the charitable donations it receives and the gross profit generated through the NHS Natural Health School.

To read about another complementary therapy initiative, this time providing treatments (Aromatherapy, Therapeutic Massage and Reflexology) to patients diagnosed with cancer who live in the Fife and Perthshire areas of Scotland, search The Circle of Comfort charity website.

Cancer is an indiscriminate and all-pervasive class of diseases that needs to be combated at every opportunity by as many health professionals as are qualified and available to contribute, including by CAM practitioners whether they are practising within the NHS or in private practice. 

I leave the ‘last words’ of this article to the Professional Standards Authority, which, on the 12^th March 2015, issued the following press release  [74] (Note: bolding of text has been added by me):

“Having confidence in Accredited Registers covering health sciences, talking therapies, physical therapies and a range of complementary therapies means that we no longer have to depend solely on doctors and nurses but can create broader multidisciplinary teams. We must invest in prevention and wellbeing to deliver healthcare for the 21st century, and that means taking a wider view of the health and care workforce.”

Richard Eaton

Richard writes a quarterly Complementary Medicine Roundup blog for The College of Medicine, London [https://collegeofmedicine.org.uk/complementary-medicine-blog/]. Extracts from his blog have been adapted and included in this article.

A print version of this article will be published in Homeopathy in Practice, the journal of The Alliance of Registered Homeopaths.

Reference links referred to in the text of the article

Note: Where the links in the text are not given below, please search the relevant document or website by copying its title or address into your browser.

1.  https://www.ncbi.nlm.nih.gov/pubmed/26758628?log$=activity

2.  http://www.legislation.gov.uk/ukpga/Geo6/2-3/13/section/4

3.  https://www.cnhc.org.uk/sites/default/files/Downloads/Enews-Feb2016-issue76.pdf

4.  https://www.cnhc.org.uk/sites/default/files/Downloads/CNHCResponse-Charity-Commission-Consultation.pdf

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7.  https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0799

8.  https://www.royalmarsden.nhs.uk/your-care/supportive-therapies

9.  https://shared-d7-royalmarsden-public.s3.amazonaws.com/files_trust/s3fs-public/Your_guide_to_support_practical_help_and_complementary_therapies.pdf

10.  https://www.macmillan.org.uk/

11.  https://be.macmillan.org.uk/be/p-265-cancer-and-complementary-therapies.aspx

12.  https://www.macmillan.org.uk/information-and-support/coping/complementary-therapies/complementary-therapies-explained

13.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/598752/The_use_and_promotion_of_complementary_and_alternative_medicine.pdf

14.  https://europepmc.org/

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17.  https://www.cochranelibrary.com/

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19.  https://www.cancerresearchuk.org/our-research

20.  http://www.positivehealth.com/researches/cancer

21.  http://www.rccm.org.uk/node/11

22.  https://www.evidence.nhs.uk/

23.  https://www.eacr.org/

24.  https://www.icr.ac.uk/our-research/about-our-research

25.  https://www.worldwidecancerresearch.org/projects/

26.  https://www.rarecancerseurope.org/

27.  https://www.carstens-stiftung.de/artikel/kurse-zur-integrativen-onkologie-akupunktur-kunsttherapie-uvm.html

28.  http://www.azkim.de/en/research/rtg/

29.  https://www.carstens-stiftung.de/artikel/4-promotionsstipendien-an-der-universitaet-heidelberg.html

30.  https://www.carstens-stiftung.de/habilitationsprogramm.html

31.  https://www.carstens-stiftung.de/newsletter.html

32.  https://anhinternational.org/

33.  https://www.oatext.com/scientific-rationale-for-integrative-and-personalised-strategies-for-pancreatic-ductal-adenocarcinoma-management.php?utm_source=The+Alliance+for+Natural+Health&utm_campaign=e62a094800-EMAIL_CAMPAIGN_2017_11_16&utm_medium=email&utm_term=0_aea8a87544-e62a094800-84983041

34.  https://www.carstens-stiftung.de/artikel/dufttherapie-hilft-auch-bewusstlosen-palliativpatienten.html

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44.  https://www.gov.uk/government/policies/cancer-research-and-treatment

45.  https://collegeofmedicine.org.uk/about/

46.  https://collegeofmedicine.org.uk/nurses-are-vital-to-progressive-integrated-healthcare-because-they-have-the-trust-of-patients/

47.  https://www.rcn.org.uk/

48.  https://www.nmc.org.uk/

49.  http://www.pulsetoday.co.uk/

50.  https://interactives.commonwealthfund.org/2017/july/mirror-mirror/

51.  https://www.cnhc.org.uk/sites/default/files/Downloads/Enews-Feb2016-issue76.pdf

52.  http://yestolife.org.uk/

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58.  http://www.positivehealth.com/articles/cancer

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61.  http://www.positivehealth.com/review/the-truth-about-cancer-what-you-need-to-know-about-cancer-s-history-treatment-and-prevention

62.  http://www.nhsconfed.org/

63.  https://www.nuffieldtrust.org.uk/

64.  http://napc.co.uk/

65.  https://bettervaluehealthcare.net/

66.  https://improvement.nhs.uk/

67.  https://www.nationalvoices.org.uk/

68.  https://www.healthwatch.co.uk/what-we-do

69.  https://www.kingsfund.org.uk/

70.  https://www.health.org.uk/

71.  https://www.professionalstandards.org.uk/home

72.  https://www.rsph.org.uk/

73.  https://www.professionalstandards.org.uk/docs/default-source/publications/untapped-resources---accredited-registers-in-the-wider-workforce-november-2017.pdf?sfvrsn=0

74.  https://www.professionalstandards.org.uk/docs/default-source/press-releases/150312-press-release-for-accredited-registers-programme-report---england.pdf?sfvrsn=8ebc7e20_0

Addendum: In my previous article, The UK National Health Service should Engage with Complementary and Alternative Medicine, I referred to a press release dated 16.06.17 as being issued by The Swiss Federal Government whereas it was published by The Swiss Umbrella Association for Complementary Medicine/The Union of Associations of Swiss Physicians for Complementary Medicine advising that: ‘…The Swiss Federal Government announces that specific medical services using complementary medicine are to be covered by mandatory health insurance (basic insurance)…’ together with further explanation.

Further Information

Richard Eaton’s book Business Guide for Health Therapists: How to find what you need to Know is available (price: £5.99):

In print as a coil-bound paperback from www.lulu.com (Bookstore);

In print as a paperback and as a Kindle/e-book from amazon

As an e-book from a variety of digital stores