Treatment approaches for cancer no longer straightforward

Receiving a diagnosis of cancer is life-changing. Sociology Professor Kevin Dew looks at the complexity of choice when it comes to selecting programmes of treatment.

tiny white pills coming from a brown bottle on a leaf
Receiving a diagnosis of cancer is a life-changing event for most people, provoking intense emotional responses, and existential questions like “Why me? What is this for?" and "What does it mean?” But there are many differences in what people do with that diagnosis, and for many that may include using alternative medicine.

This variety of approaches taken by people in combining, or not, orthodox, and alternative medicine could suggest that the simple dichotomies that we use—orthodox/unorthodox, mainstream/alternative, and so on do not serve us well.

In my recent book on complementary and alternative medicine, as well as in my current Marsden-funded research, I have encountered many different roles that alternative medicine plays for people who have a cancer diagnosis.

For some, alternative medicine plays no role at all, as they hold to the belief that alternative medicine that works is simply “Medicine”. But for many people—in fact, some studies suggest up to 90 percent of people with a cancer diagnosis—alternative medicine plays some role in their response to cancer.

Few people reject orthodox treatment outright, and I am using orthodox here in the sense of the standard treatments offered by oncologists and their teams in hospitals. However, some people may rely on alternative medicine alone for the treatment of cancer where they have been given a very poor prognosis and where the harsh treatments of orthodox approaches, for example, chemotherapy, might significantly reduce the quality of life in a situation where life expectancy is very short.

More commonly, alternative approaches are used as a complement with orthodox treatment. These approaches, which include supplements and dietary changes, may be used to support general health so that the toxic effects of chemotherapy can be handled better. Some people who feel they have done better than others receiving the same treatment may suggest that this is thanks to these complementary approaches which weren’t prescribed by their oncologist or any other orthodox medical practitioner.

For others, alternative therapies might be used to help with anxiety and fear—for example using approaches such as visualisation and meditation. Even with a poor prognosis, people may combine orthodox treatment with alternative approaches on the “off chance” that it will help.

Alternative medical approaches are not just prescribed by alternative practitioners such as naturopaths, homeopaths, and herbalists, but can be prescribed, albeit less commonly, by oncologists. In my research, I have never come across orthodox practitioners refusing to treat patients who try out alternative approaches to cancer. If the alternative approaches are not seen as interfering with the orthodox treatments of chemotherapy and radiation therapy, then they are tolerated.

This is not necessarily the case overseas. Studies in the United States, for example, found up to one in twelve doctors caring for cancer patients have refused to treat those using alternative approaches.

And, despite what I noted earlier, even in Aotearoa, problems do occur.

In earlier research I was involved in, a participant reported that she wanted to use rongoā medicine to deal with her cancer but was told by the oncologist that she would be dead if she did that. So rather than working with the patient, the practitioner created a barrier for her that meant she did not continue to engage with the orthodox healthcare system. Perhaps fear of such breakdowns explains why research shows most cancer patients who use alternative therapies do not tell their health professionals—although for many patients they just might not think that such use is relevant to their orthodox doctor.

I think it might serve us better to acknowledge that we are in a situation of therapeutic pluralism . Cancer sufferers are confronted with a variety of options, not just the options that might be presented to them by their oncologist, and have to make decisions about what options to take.

There will be many pressures on people to make particular decisions. Those around them may prefer that they just do what the doctor tells them, but others may encourage them to explore what else might help, and others still may strongly advocate for specific alternative approaches. This can make the decision around how to respond to cancer one that goes well beyond the consultation room between the oncologist and the patient. Therapeutic possibilities arise across a patient’s networks of friends, relatives, and colleagues, crossing generations and extending beyond fixed geographical locations when so much material can be accessed through the internet.

Although therapeutic pluralism might not be embraced by orthodox medicine, the reality is that cancer patients are likely to combine a range of different approaches. My current Marsden research involves talking to people who have survived cancer for longer than expected—how, why, if and when people draw on different approaches to healing is one strong theme that has come through in that research. Perhaps we all need to have a greater awareness that navigating this field of therapeutic possibilities is not always easy.