Cancer care goes complementary
 

By Jerome Burne
Times Online
June 11, 2005

Alternative therapies are moving into mainstream medicine as NHS oncology departments link up with a homoeopathic hospital

Although many doctors still raise an eyebrow at the mention of homoeopathy, this 200-year-old system of minuscule dosing is proving remarkably resilient. Next week the Royal London Homoeopathic Hospital in Greenwell Street, W1, is reopening after an £18.5 million makeover.

But alongside the continued prescribing of such venerable remedies as Armoracia rusticana for bronchitis and Nux vomica for digestive complaints a less familiar aspect of its services is being expanded.

Described as “one of the best-kept secrets of the NHS”, this is the hospital’s complementary cancer service that, together with homoeopathy, offers acupuncture, massage and herbal treatments to referred patients, all for free. The revamped hospital will be integrated with the mainstream oncology department at the nearby University College Hospital.

“The director of our cancer services will hold a clinic there once a week to assess patients who might benefit from our approach,” says Dr Peter Fisher, the clinical director of RLHH. Patients are also regularly referred from other leading cancer centres such as the Royal Marsden.

It is one of the strongest signs that a complementary approach to cancer is coming in from the cold. Mainstream medicine has a long history of being hostile to it, which is one reason why it is estimated that over half of the patients using it don’t tell their doctor.

Last summer, for instance, the Prince of Wales was told off by the eminent cancer specialist Professor Michael Baum for mentioning someone who had had good results with the controversial Gerson diet.

But there are also signs that mainstream attitudes are changing and, increasingly, oncologists accept that the complementary approach has a role. Leading figures on both sides have recently been calling for studies to show what works and what doesn’t.

One of these is Professor Leslie Walker, a researcher with the charity Cancer Research UK, who said that “patients can benefit psychologically when information, support and access to evidence-based complementary therapies are offered”.

Last autumn the charity set up a committee of practitioners of complementary medicine to put forward research proposals. “There is evidence that some treatments can be beneficial, such as acupuncture for nausea,” says Dr Richard Sullivan, the head of clinical programmes. “If other ones are going to be used on the NHS, they have to be backed up by evidence.”

This is the approach taken by the director of the RLHH cancer service, Dr Sosie Kassab. “We don’t claim to cure anything,” she says, “but the treatments we use all have good evidence that they can help with chemotherapy’s side-effects.” The packages that she puts together for her patients combine acupuncture, herbs and homoeopathy with the massage techniques of shiatsu, reiki, reflexology and aromatherapy.

Further support for using evidence-based complementary and alternative medicine (CAM) came from a European-wide study in February which found that, on average, it is used by a third of cancer patients in Europe.

“Irrespective of what health professionals believe about CAM,” said the study’s author, Dr Alex Molassiotis, of the University of Manchester, “this shows the need to move towards integrating into the mainstream those therapies for which there is evidence of effectiveness.” But while everyone agrees that gathering evidence makes sense, less than half a per cent of the UK medical research budget goes on complementary medicine. At that level of investment, it will take centuries to establish a solid evidence base and cancer patients’ horizons are often measured in years. Is it possible, for instance, as is claimed by many practitioners, to boost your immune system with various diets and supplements to protect it from the battering dished out by chemotherapy? “People can’t wait for full-scale clinical trials that will take years to produce results,” says Dr Rosy Daniel, an integrated medicine consultant, who was the medical director at Bristol Cancer Help Centre for years and has now set up an organisation called Health Creation. “They need information right now.”

Health Creation is one of three organisations in the UK that would be good places to find the complementary options that might work for you (see box). All contain up-to-date information that has been compiled by people who are active and knowledgeable in the field. The treatments don’t have the level of proof that everyone agrees would be ideal but often there is more evidence — small studies, cell cultures, long experience — than the dismissive approach of the mainstream might lead you to believe.