The alternative practitioner does not treat the patient like another NHS number, on average they spend between one to two hours with the patient instead of the usual five minutes. Complimentary and alternative medicine treats ill health not as a mechanical fault but a lack of harmony between the body, mind, and self. It seeks to use the bodies own healing mechanisms and not high-powered drugs to restore the lost balance.
Complimentary and alternative medicine is known by the acronym, CAM, Zollman et al (1999 p694) state that
“Complimentary and Alternative medicine (CAM) is a broad domain of resources that encompass all health systems, modalities, and practices and their accompanying theories and beliefs. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting well-being”.
There are many forms of complimentary therapies (a list of common complimentary therapies is included in Appendices 1). (Zollman et al 1999 p 695). The list is not exhaustive as new branches of CAM are continually being developed.
In 1983, the British Medical Association’s Board of Science and Education commissioned a working party to assess the practice of complementary and alternative therapies. The report published in 1986, identified the dissatisfaction of the public with the increasingly technical approach to medicine, the division of care due to specialization, and the loss of the bedside skills as contributive factors to the increased popularity of complimentary therapies. It noted the heightened expectations of the public caused by sensational reporting of miracle cures in the media. However, Learner (1984 p817) suggested that the most important reason for the success of complimentary and alternative medicine might be due to the failure of science and medicine to produce curative measures for commonly occurring types of cancer.
Traditional care for terminally ill patients emphasizes the use of medical interventions, hospitalization, and drugs to cure or control disease and may involve aggressive high-tech drugs. The traditional approach is used both when a cure is expected and when a cure is not possible. However, this is not the only choice.
The philosophy of many hospices reflect a holistic approach; both biomedicine and complimentary therapies are used in conjunction encompassing the physical, psychological, and spiritual aspects of care, and are sensitive to the well being of the patients. Some complimentary therapies are provided; these may include, aromatherapy, reflexology and massage therapy, other therapies, such as counseling, are part of the standard treatment for patients at the hospice, as doctors acknowledge the positive effects that professional counseling can have on a patient’s well being. The complimentary therapies, such as aromatherapy, reflexology, and massage, while not part of standard treatment, are accepted at spring hill hospice and indeed at other establishments because patients have reported that these therapies help them to feel better and cope better with their illness.
According to Thomas et al (1991 p207) when patients are asked, what attracts them to alternative therapies, some said they felt more hopeful than when using conventional treatments alone, and were attracted to the holistic nature of the therapies. Others have become to use complimentary therapies during or after the time they were receiving active conventional treatments. Downey (1994 p8) suggests that much of the attraction of these unorthodox forms of treatment is due to their holistic philosophies based on the principle of the whole body: the recognition that our bodies, minds and spirits are all related and effect each other.
Studies have shown that significant numbers of adults in Britain and other countries have used complimentary or alternative therapies. In 1989 the BMJ reported that about one in eight Britons use complimentary therapies. (Cited in BMJ 1994 p 86).
A more recent research study conducted by the BBC has shown that complimentary and alternative medicines are becoming increasingly popular. The number of people using complimentary medicine has doubled over the past six years, according to a survey carried out for the BBC. The survey of 1,200 people showed that seventy eight per cent of those surveyed believe that complimentary health treatments will become increasingly popular. The results showed that twenty one per cent had used a complimentary medicine or therapy in the last year – double the number found to be using them in a similar survey six years ago. The majority of the people surveyed said the main reason they used complementary and alternative medicine was because it worked for them, but other reasons given includes that it was relaxing and that it helped to prevent illness. One in ten people were referred to an alternative therapist by their doctor, but an equal number referred themselves because they said they did not believe in conventional medicine.
The poll also revealed that the shift towards alternative therapies might be saving the NHS money. People taking part in the survey spent on average £13.60 a month on alternatives and those aged between 18 and 24 spent an average of £18.60 – totaling £223 a year.
A recent small-scale study has been carried out by staff at the Breast Care Unit at Huddersfield Royal Infirmary into the value of using aromatherapy massage to relieve lymphoedema (lymph accumulates in the subcutaneous tissue, causing the effected limb to become swollen and tender) the study involved women at various stages of recovery.
The nurses used the manual lymph drainage technique with aromatherapy to relieve lymph drainage and soften the affected tissues. They gave at least six sessions of massage with Lavender oil lasting 20-30 minutes. The patients were then asked how they felt after the treatments. All the patients reported some benefit in terms of relaxation; some also said that there was some alleviation of pain, reduction in swelling and improved self-esteem. (Cited in Journal of International Therapists issue 9 p 11).
A research study conducted at the Marie Curie Center in Liverpool, was set up to assess the effects of aromatherapy massage on cancer patients receiving palliative care. Patients received three full body massages over a three-week period, with or without the essential oil Roman chamomile. The group that received the aromatherapy massage was found to have statistically significantly improved quality of life, stress and anxiety were said to have been improved and responses to the post-therapy questionnaire indicated that patients consider aromatherapy massage to also be beneficial in reducing tension, pain and depression. (Cited in Buckle 1997 p233).
Wilkinson (1995 p21) suggests that there is a deficiency of good-quality empirical evidence justifying aromatherapy practice. Buckle (1997 p235) suggests that aromatherapy is not deemed as a cure for cancer, but is seen as a way to enrich interventions, and bring comfort and be of much value in bringing better health to patients with cancer. In contrast to Wilkinson’s statement, Buckle argues that aromatherapy appears theoretically to be a promising treatment. Whilst, according to Jackson, (1997 p4) there is substantial evidence to suggest that aromatherapy can be a valuable therapy for many patients, recent research studies confirm that aromatherapy has an important role to play in palliative nursing.
Some of the criticisms leveled at aromatherapy have cited the paucity of research; it is a fair comment, as research is limited. However, aromatherapy has gained wide popularity amongst nurses in their clinical practice.
Essential oils and massage are being used increasingly by nurses in palliative care settings with beneficial results being noted in many cases. This has stimulated experimental studies to be set up in an attempt to provide a firmer basis for anecdotal and unreliable experiences. Wilkinson (1995 p 21) set up a study to assess the effects of aromatherapy massage on cancer patients, one group receiving a full body massage with carrier oil only, and the other receiving one per cent roman chamomile oil in the same carrier oil (sweet almond oil). So far, fifty-one patients have taken part in this study, which is ongoing, and only preliminary results have been reported. The results show that the patients’ perceptions as to the value of aromatherapy massage appear to be very positive, but the formal statistical analyses are inconclusive. Dr. Susie Wilkinson concludes that although the results are promising the study needs to be completed with a greater number of patients. What is needed is a major research movement to prove what the ‘evidence’ shows.
Another study initiated by the Institute of Cancer Research reported on the effects of an eight-week course of massage, with or without the addition of a blend of essential oils, on patients undergoing cancer treatment. The blend consisted of lavender, rosewood, lemon, and rose, in a concentration of two per cent sweet almond oil.
The study appears to demonstrate that massage, with and without essential oils, is an acceptable and beneficial intervention to use with cancer patients. Statistical analysis was inconclusive. (Cited in Journal of Palliative Nursing, 1995, issue two p 67).
Hildebrand (1994) depicts aromatherapy as:
‘One of the principal methods of the use aromatherapy is with therapeutic massage, which, combined; give a holistic approach to the care of a client. Aromatherapy is not by any means fully understood, but its profound and sometimes dramatic effect on the senses, has been observed through its history and was described by Mme Maury, the pioneer in aromatherapy, as ‘the purest form of living energy that we can transfer to man’. ( cited in Wells 1994 p 125).
In summary, aromatherapy should not be thought of as a cure for cancer, but as a way to enrich interventions and bring comfort and better health to patients with cancer. Aromatherapy can help to enhance not only the quality of life to cancer patients but also the quality of their care.
According to Mason (1994 p117) Massage is one of the oldest and simplest forms of physical remedy employing an holistic approach to health and illness and is perhaps the least contentious or controversial of any complimentary therapy. Hilderbrand (1994 p106) suggests the value of massage therapy is becoming more widely accepted by the publics awareness of its therapeutic value.
Massage has gained wide popularity amongst nurses in their clinical practice in recent years, and is one of the complimentary therapies utilized at spring hill hospice, according to Jones (1998 p53) it is used in many cancer clinics in the UK, having shown to be physically and psychologically beneficial in relieving anxiety and tension.
A study by Palmer (1997 p21) looked into the effect of massage in patients with advanced cancer and patients’ perceptions as to the value of massage in improving their quality of life. In those that responded to a survey after massage, all patients indicated liking some aspects of their massage and forty-five out of the forty-eight respondents said they had derived some benefit. All reported that relaxation was a positive aspect of massage with some reporting that this continued after the massage; pain reduction was referred to by sixteen out of the forty-eight patients, and ten patients referred to physical benefits such as improved mobility and an improved skin condition. About half of the group found that the positive aspects of their massage had been mainly emotional or spiritual compared to the other half who started it to be of benefit physically.
A great deal of empirical research is carried out by practitioners in their clinical setting. A large amount of work is investigated by using case studies, for example, Hilderbrand (1994) reported a woman in her early sixties with breast cancer who had recently had a mastectomy (breast removal) who was referred because of tension and aches and pains in her neck. She was treated with a very light back massage with Lavender and Bergamot, essential oils blended in grape-seed oil. After her massage therapy, she was asked to describe the effects of her treatment. This is how she described her treatment:
‘I consider the massage treatment I had today has been very beneficial in relieving the muscle tension and post-operative pain associated with my breast operation. I would recommend that this treatment be offered to other patients in similar circumstances’. (cited in Wells 1994 p 114).
The above experience is anecdotal in nature, there is a clear need for further specific investigations into the actual benefits of massage and essential oils. It is clear that larger clinical trials would form a firmer basis for such anecdotal experiences.
Conventional approaches to cancer treatments have generally been studied for safety and effectiveness through rigorous scientific processes, including clinical trials with large numbers of patients. Often, less is known about the safety and effectiveness of complimentary and alternative methods. Some complementary and alternative therapies have not undergone rigorous evaluation. Others, once considered unorthodox, are finding a place in cancer treatment, not as cures but as complimentary therapies that may help patients feel better and recover faster.
Funding for research into complimentary medicine the UK is miniscule compared with the USA. It seems that NHS primary care groups and health authorities are reluctant to spend significant sums of money on con-conventional approaches without evidence of cost-effectiveness. Nevertheless, because few complementary and alternative therapies are available on the NHS, there is little or no incentive to divert limited funds into research. The tragedy is that, even in a priority area like cancer, there are well-founded suggestions those additional simple interventions such as aromatherapy and massage could save thousands of pounds in medication costs and improve the quality of life of many patients.
HRH The Prince of Wales and indeed the whole royal family are great believers of holistic medicine. The Prince is quoted as saying ‘I am personally convinced that many people could benefit from complimentary medicine’. (cited in Jones 1998 p 66).
HRH The Prince of Wales spoke at St James’s Palace in 1997, in celebration of the centenary of the King’s Fund, of which he is President:
‘Many studies into complementary and alternative medicine are carried out abroad, in the US, the government’s National Center for Complimentary and Alternative Medicine (NCCAM) has a research budget of $68 million (dollars) a year. In the UK figures from the Department of Complementary Medicine at the University of Exeter show that less than 8p out of £100 spent of NHS funds for medical research was spent on complimentary medicine. In 1998 the Medical Research Council spent no money on it at all, and in 1999 only 0.05% of the total research budget of the UK medical charities went to this area’.
The Prince suggested that a National strategy for alternative medicine, with new funding for the Foundation for Integrated Medicine, which could provide a to coordinate this strategy, allocate funding, provide a networking resource, train researchers, disseminate information and monitor research development. He also suggested that serious funding is needed for bursaries, fellowships, research centers, and support for ‘fledgling’ researchers. When the future King of England speaks out and encourages the modern NHS to embrace alternative and complementary medicine, people sit up and take notice.
Bibliography
Barber P. 1996 The Soul in Professional Health Care Published by Pollity Press London p 85, 79, 53.
BBC News Health: Britons turning to alternative cures available from:
BMA 1983 ‘Alternative Therapy’ Report of The Board of Science and Education London BMA 1986 p 75.
BMJ 1989 The Status of Complementary Therapy BMJ 1994;309: 86-89 (9 July) p 86 available from:
Buckle J 1997 Clinical Aromatherapy in Nursing Published by Arnold London p232, 235.
Downey S 1994 in Rankin-Box Complementary Health Therapies: A Guide for Nurses and Caring Professionals Published by Chapman and Hall London 1994 p8.
Endacott M 1999 Complementary Medicine is Holism in Practice Journal of Complimentary Therapies in Nursing and Midwifery Volume 5 Number 4 August 1999 p115.
Hilderbrand S 1994 in Wells’ Supportive Therapies in Health Care published by Balliere Tindall London p125, 106, 114.
HRH The Prince of Wales Speech on the Values of Complementary and Alternative Therapies available from:
Institute of Cancer Research effects of an eight-week course of massage Journal of Palliative Nursing 1995 Issue 2 p 67.
Jones H Doctor 1998 What’s the Alternative Published by Hodder and Staughton London p63, 24, 25, 66, 53.
Learner I J 1994 The Why’s of Cancer Quackery Cancer (Journal) Issue 53 Pages 815-9 p 817.
Mason A 1994 IN Rankin-Box DF Complementary Health Therapies: A Guide for Nurses and the Caring Professions Published by Chapman and Hall London p 117
Moule T 2000 Cancer the Healthy Option Published by Parliamentary Press London p 75.
Palmer J 1997 Research Highlights: the possible benefits of massage Journal of International Therapists Jan/Feb 1997 Issue 14 p21
Pietroni P 1986 Holistic Living: A Guide to Self Care Published by Dent and Sons Ltd London 1986 p 1.
Shillings C 1994 the Body and Social Theory Published by Sage London p 55
Staff at the Breast Care Unit at Huddersfield Royal Infirmary; Massage and Breast Cancer Journal of International Therapists Issue 9 p11.
Thomas et al 1991.The Use of None Orthodox and Conventional Health Care in Great Britain BMJ 1991, 302:207-10 available from:
Wilkinson S 1995 Aromatherapy and Massage in Palliative Care International Journal of Palliative Nursing Issue 1 Pg 21 available from:
Zolman C and Vickers A What is Complementary Medicine BMJ 1999, 319:693-696 (11 September). Available from:
Appendices 1
Common Complementary Therapies
- Acupuncture
- Alexander Technique
- Applied Kinesiology
- Anthroposophic medicine
- Aromatherapy
- Autogenic training
- Ayurveda
- Chiropractic
- Cranial osteopathy
- Environmental medicine
- Healing
- Herbal medicine
- Homeopathy
- Hypnosis
- Massage
- Meditation
- Naturopathy
- Nutritional therapy
- Osteopathy
- Reflexology
- Reiki
- Relaxation and visualisation
- Shiatsu
- Therapeutic touch
- Yoga (List by Zolman C and Vickers A)