When a mysterious illness strikes, people may become more open to using complementary and alternative medicine (CAM) to get well.
This is also the case when the illness is a severe one. Cancer patients often explore alternatives such as traditional Chinese medicine (TCM), homeopathy or products like herbs and vitamins in the belief that they can strengthen their immunity or fight the disease.
Two recent studies done in Singapore acknowledge the widespread use of CAM among people here and conclude that CAM may sometimes do more harm than good.
HELP FOR RHEUMATOID ARTHRITIS
One of the studies found that the use of CAM led to a delay in patients seeking medical help for early inflammatory arthritis or the early stage of rheumatoid arthritis.
Inflammatory and rheumatoid arthritis are autoimmune diseases that cause chronic inflammation of the joints and other areas of the body. They are different from osteoarthritis - the most common form of arthritis - which is wear and tear of the cartilage.
Estimated maximum number of people in Singapore who have rheumatoid arthritis.
Early arthritis patients who can go into remission after six to 12 months of being treated with disease- modifying anti-rheumatic drugs.
Those who stand a good chance of avoiding major joint damage and the need for joint replacements.
Osteoarthritis can cause joint damage requiring joint replacement. It is not treated with disease- modifying anti-rheumatic drugs (DMARD) as it is a wear-and-tear problem and not inflammation.
In the study of 180 patients with early inflammatory arthritis, 74 patients (41 per cent) used CAM before seeing a specialist.
CAM users tended to delay treatment by an extra six weeks, compared to non-CAM users. The study found that the median time from symptom onset to starting the first dose of anti-rheumatic medication was 15.6 weeks for non-CAM users and 21.5 weeks for CAM users.
Oral tablets or powder (55 per cent) and acupuncture (47 per cent) were the most common types of alternative medicine used.
Researchers pointed out that the earlier rheumatoid arthritis is treated, the better the outcome.
"There's a window of opportunity for treatment of early rheumatoid arthritis. Six months or less is considered early arthritis - it's much easier to switch off the immune trigger," said Dr Manjari Lahiri, the study's lead author and a senior consultant at National University Hospital's division of rheumatology.
Research shows that up to 60 per cent of early arthritis patients can go into remission after six to 12 months of being treated with DMARD, she said. During this time, treatment is closely monitored and medication continually adjusted.
"The remaining 40 per cent stand a good chance of avoiding major joint damage and the need for joint replacements."
Aside from joint damage and disability, patients who delay starting medication could end up needing joint replacement surgery (for permanently damaged joints).
An estimated 25,000 to 50,000 people in Singapore have rheumatoid arthritis but not many know it can be treated. "People equate it with rheumatism, which is not considered a serious disease," said Dr Lahiri. Rheumatism is a term commonly used for feeling achy.
If you have spongy swellings over several joints and feel a "niggling pain" or are often tired, it could be rheumatoid arthritis, she said.
"It's not just the pain, patients feel run down because their body is inflamed. Their hands and wrists get affected, so turning the door knob and opening a jar can be hard. When they wake up, they feel stiff."
Dr Lahiri added: "Patients should avoid tablets and powders as we don't know their content, how they interact with Western medicine and the toxicity they may cause."
ASK ONCOLOGISTS ABOUT CAM USE
In the second CAM-related study, it was found that a decision aid - a booklet that discusses CAM and whether it is safe - may reduce the use of such medicine among cancer patients.
It may encourage patients to discuss the use of CAM with oncologists. "CAM is widely used by patients doing chemotherapy treatment, but some of them do not inform their oncologists about it," said Dr Chong Wan Qin, an associate consultant oncologist with the National University Cancer Institute, Singapore, and the study's lead author.
The ongoing study, started in 2014, recruited 240 cancer patients with an average age of 55 years. Most of them had breast, colorectal or lung cancers, which were mostly in the advanced stage.
Up to 20 per cent of them used oral CAM while on chemotherapy. The most common were vitamins and supplements (40 per cent of patients) and TCM (30 per cent).
Reasons given by patients were that they wanted to cure the cancer or do more to fight it (35 per cent), boost immunity (30 per cent) and improve well-being (20 per cent).
There is emerging evidence that some kinds of complementary therapy can help patients cope with the side effects of cancer treatment. Acupuncture has been shown in trials to be effective in the treatment of nausea and vomiting due to chemotherapy, for instance.
However, doctors do not advise patients to take alternative drugs as they could turn out to be harmful.
Some herbs can reduce the effectiveness of chemotherapy treatment while others may increase the side effects of chemotherapy. Some herbs can also act like drugs and cause side effects when taken in high doses.
Dr Chong said one example is ginseng, a seemingly harmless natural product. Excessive use can cause headaches and high blood pressure.
Ginseng may also cause certain chemotherapy drugs to work less well, she said.
"Oncologists have also heard of patients using coffee enema. It is not backed by medical evidence and may cause diarrhoea and electrolyte loss."
Vitamin C infusion is another example with no evidence to support its efficacy.
Dr Chong has seen patients who wanted to test alternative therapies, such as a special ketogenic diet, instead of going for chemotherapy and radiotherapy treatments.
Because all cancers have a better chance of control and survival outcomes when treated early, by the time these patients returned for chemotherapy, their cancer had progressed and impaired some of their organ functions, she said.
When the organ functions are impaired, chemotherapy poses a higher risk of toxicity, she said.
The use of CAM may delay the treatment of serious diseases and this can lead to adverse effects.