A Methodological Framework for Evaluating the Evidence for Complementary and Alternative Medicine (CAM) for Cancer

Abstract

In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning effects of CAM can and should be produced, and how the existing evidence should be interpreted. This represents a considerable challenge for oncologists; both in terms of patient needs for an informed dialogue regarding CAM, and because some types of CAM may interact with standard treatments. There is a need for insight into which kinds of CAM may work, for whom they work, what the possible effects and side-effects are, and in what ways such effects may come about. The present article presents a framework for evaluating effects of CAM by suggesting a taxonomy of different levels of evidence related to different types of research questions and discussing the relevance of different research methodologies for different types of effects.

An assessment of the impact of herb-drug combinations used by cancer patients

“…Another important issue is how the lack of evidence of HDS safety and efficacy should be addressed, as well as how the current evidence should be interpreted. In other words, there is a strong demand for an appropriate and robust framework for evaluating HDS safety and efficacy at different levels of patients’ needs, which includes social, epidemiological, and clinical studies [ 36 ].…”

Acupuncture as a tool to reduce nausea in terminally ill patients

“…Although this was a CER study, we consider this as strong evidence. Many practitioners consider the patient's subjective experience of a symptom reduction to be the most important criterion [13]. Other researchers have emphasised that conducting pragmatic trials comparing acupuncture plus standard care and standard care alone may provide results that can directly inform clinical practice [14].…”

Key Issues in Clinical and Epidemiological Research in Complementary and Alternative Medicine – a Systematic Literature Review

“…In some publications, explicit research questions and appropriate methods were given by the authors [2,5,[7][8][9][10][11]. However, there was clear agreement about the value of different research methods in CAM research [12][13][14][15][16].…”

“…This can help to establish a patient-centred mechanistic understanding of the intervention and its impact, irrespective of whether mechanisms and objective outcomes of treatments are known [16,26,56,[97][98][99][100]. Qualitative research is unsuitable when trying to establish causal relationships or specific physiological outcomes [101], but is relevant for the investigation of changes in subjective approaches to health and illness [5]. Specific qualitative research methods have been introduced in the literature, such as ethnographic research, interviews and focus groups [5,16,98,[102][103][104].…”

“…Qualitative research is unsuitable when trying to establish causal relationships or specific physiological outcomes [101], but is relevant for the investigation of changes in subjective approaches to health and illness [5]. Specific qualitative research methods have been introduced in the literature, such as ethnographic research, interviews and focus groups [5,16,98,[102][103][104]. Case reporting and case studies are particularly valuable to establish complex and contextualised views …”