Comforting Cancer Patients With CAM

Short of finding a cure for their animal with cancer, oncology clients want ways to reduce their animal’s suffering. While some elect euthanasia, many would consider otherwise if provided effective options. Maximizing comfort and minimizing pain usually requires multimodal analgesia due to the unique challenges that cancer pain poses.¹ Typically, this involves a combination of conventional and complementary and alternative medical intervention.² The American Cancer Society and the National Comprehensive Cancer Network cancer pain practice guidelines ask that clinicians recommend nonpharmacologic measures if pain remains uncontrolled despite pharmacologic management and re-evaluation.³

Pain Complexities

What makes cancer pain complex? One reason concerns the physiology of tumor pain itself. Chemical interactions between cancer cells and sensory neurons appear to contribute to tumor pain. Researchers recently showed that increased numbers of voltage-gated calcium channels mediate mechanical hyperalgesia in a fibrosarcoma cancer model.⁴ Other issues also make cancer pain unique.Dogs post-amputation require special attention to the myofascial and spinal restrictions they will develop along their back, neck and remaining limbs. Patients receiving radiation therapy need pain relief for the glandular disruptions in head and neck cancers and severe tissue reactions in general. Chemotherapy can pose a variety of challenges to quality of life. Carefully integrating CAM can support animals and thereby encourage completion of conventional treatment.⁵

In fact, a majority of clients are already providing CAM options for their dogs and cats with cancer by the time conventional treatment ensues. According to a 2006 survey of clients who brought their animal to the Colorado State University Animal Cancer Center, 76 percent of surveyed owners admitted to using CAM for their animals with cancer.⁶ Most did so to improve well being; other reasons included attempts at reducing pain and treatment toxicity and improving appetite. Furthermore, a majority of those surveyed had not yet spoken to their veterinarian about CAM, indicating a need for veterinarians to broach the subject.

Complications to Consider

Not all CAM modalities fit every cancer patient. Herbs and antioxidants may alter drug effectiveness. Patients with osteosarcoma, skeletal metastasis, spinal instability, low platelet counts or osteopenia should avoid chiropractic and deep massage. Raw-food diets present accentuated disease hazards in immunocompromised patients. Immune-stimulating herbs may counteract chemotherapy for lymphoma. As indicated by researchers from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, “The problems and concerns regarding the risk of interactions with prescription drugs dominate the discussion of healthcare professionals and researchers about the use of herbs and supplements by cancer patients receiving conventional cancer therapy." ⁷

On the other hand, appropriately selected CAM treatments augment the capacity of cancer patients to cope. Although as sudden, jarring chiropractic moves and deep visceral massage techniques have no place in cancer care, expertly performed massage may reduce problems associated with lymphedema, stress, contractures and neuropathic pain.  Instructing clients on gentle massage techniques and teaching them how to tell when their animal is hurting helps them to overcome their sense of powerlessness and dread.

Effective Analgesic Options

Of all complementary therapies studied, acupuncture brings with it the biggest weight of evidence and clarity as to its scientific basis and effectiveness. Through neuromodulation, acupuncture counteracts pain and other adverse sequelae of cancer treatment and may reduce the levels of medication required.⁸ Neuroanatomic acupuncture targets specific neural pathways affected by pain and may provide the most effective analgesia. Myofascial pain resulting from amputation, surgical tumor excision and debility from the disease itself frequently responds favorably to acupuncture.

Biofield therapies live in a subcategory under the energy therapies domain as defined by NCCAM. These techniques span ages and cultures and include energy healing, spiritual healing, Qigong, Reiki, therapeutic touch, healing touch and polarity therapy.⁹  Although the mechanism of action of energy-based treatments remains vague,¹⁰ controlled clinical trials indicate that patients’ moods and quality of life improved, while pain and fatigue lessened.¹¹,¹² Receptive clients who are motivated to learn how to implement these modalities themselves may derive substantial benefit not only by treating their animal but also from its intrinsically centering aspects that influence the provider.¹³

Studies on low level laser therapy for the prevention and reduction of oral mucositis continue to multiply.¹⁴,¹⁵ A 2007 report on a phase III, randomized, double-blind, placebo-controlled clinical trial that evaluated the efficacy of LLLT for the prevention of oral mucositis indicated that laser with a 650 nm wavelength reduced the severity of oral mucositis as well as pain scores.¹⁶ No adverse effects were noted in this study.

In summary, sidestepping dangerous herb-drug interactions will require more intensive research and study, while judicious integration of touch therapies, acupuncture and certain other complementary therapies can boost patients’ quality of life and client satisfaction.¹⁷

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FOOTNOTES:

1. McMillan FD.  Comfort as the primary goal in veterinary medical practice [Commentary].  JAVMA.  1998;212(9):1370-1374.

2. Eidelman A, White T, and Swarm RA.  Interventional therapies for cancer pain management: important adjuvants to systemic analgesics.  J Natl Compr Canc Netw.  2007;5(8):753-760.

3. Bardia A, Barton DL, Prokop LJ, et al.  Efficacy of complementary and alternative medicine therapies in relieving cancer pain:  a systematic review.  Journal of Clinical Oncology.  2006;24(34):5457-5464.

4. Khasabova IA, Stucky CL, Harding-Rose C, et al.  Chemical interactions between fibrosarcoma cancer cells and sensory neurons contribute to cancer pain.  J Neuroscience.  2007;27(38):10289-10298.

5. Deng G, Cassileth BR, and Yeung KS.  Complementary therapies for cancer-related symptoms.  The Journal of Supportive Oncology.  2004;2(5):419-429.
 
6. Lana SE, Kogan LR, Crump KA, Graham JT, and Robinson NG.  The use of complementary and alternative therapies in dogs and cats with cancer.  J Am Anim Hosp Assoc.  2006;42:361-365.

7. Deng G, Cassileth BR, and Yeung KS.  Complementary therapies for cancer-related symptoms.  The Journal of Supportive Oncology.  2004;2(5):419-429.  [Peer viewpoint provided following the article.]

8. Cassileth BR, Deng GE, Gomez JE, et al.  Complementary therapies and integrative oncology in lung cancer:  ACCP evidence-based clinical practice guidelines (2nd edition).  Chest.  2007;132(3 Suppl):340S-354S.

9. Pierce B.  The use of biofield therapies in cancer care.  Clinical Journal of Oncology Nursing.  2007;11(2):253-258.

10.Baldwin AL and Schwartz GE. Personal interaction with a Reiki practitioner decreases noise-induced microvascular damage in an animal model.  Journal of Alternative and Complementary Medicine.  2006;12(1):15-22.

11.Pierce B.  The use of biofield therapies in cancer care.  Clinical Journal of Oncology Nursing.  2007;11(2):253-258.

12.Leskowitz ED.  Phantom limb pain treated with Therapeutic Touch:  a case report.  Arch Phys Med Rehabil.  2000;81:522-524.

13.Pierce B.  The use of biofield therapies in cancer care.  Clinical Journal of Oncology Nursing.  2007;11(2):253-258.

14.Jaguar GC, Prado JD, Nishimoto IN, et al.  Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation.  Oral Dis.  2007;13(6):538-543.

15.Alterio D, Jereczek-Fossa BA, Fiore MR, et al.  Cancer treatment-induced oral mucositis.  Anticancer Res.  2007;27(2):1105-1125.

16.Schubert MM, Eduardo FP, Guthrie KA, et al.  A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation.  Support Care Cancer.  2007;15(10):1145-1154.

17.Deng G and Cassileth BR.  Integrative oncology:  complementary therapies for pain, anxiety, and mood disturbance.  CA Cancer J Clin.  2005;55:109-116.