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Chapter 1
PROBLEM STATEMENT
Introduction
In today’s society, there have been many great advances in medical technology;
however, with all the advancements, people are also suffering from many more chronic
and terminal illnesses. One of these illnesses that have increased in today’s population
is cancer. Cancer is a diagnosis that evokes feelings of fear and helplessness within the
individual. This disease is one that many people link with the diagnosis of certain
death, but before death, there is much pain and suffering. One loses their quality of life
to, not only the disease, but also to the cure itself. Usually the treatment for cancer
itself is one that forces the patient to feel weak and even sicker than the illness itself.
Because of the side effects, many people choose to stop their cancer treatments of
radiation or chemotherapy, though they are aware that their prognosis will be much
worse without the treatments. There is very little that Western medicine can do to curb
the side effects of cancer treatments.
For those within the Western culture who are accustomed to a more natural way
of healing, they tend to choose to stay with their old ways of treating illnesses, such as
using herbs in Chinese medicine. Many immigrants will continue to follow their
traditional ways of healing without informing their treating Western doctors for fear of
ridicule or being looked down upon from their Western point of view. Therefore they
may continue to use both Eastern and Western medicine together. However, if a
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professional who is knowledgeable of the effects does not monitor the mixing of both
Eastern and Western medicine, there may be adverse reactions when the different drugs
are used in conjunction. As with any patient who takes more than one medication, both
the patient and the doctor need to know all of what is being used to avoid one
medication affecting another, or to avoid the negative effects of mixing medications.
Because of the diversity in the ethnic backgrounds in our society, along with
different traditions in healing, there needs to be an exchange of knowledge between the
Western medical professionals and the traditional healing techniques of Eastern
medicinal practices. There are benefits to both sides, and if combined correctly,
tremendous benefits could be present for the patients. The benefits not only include the
physical benefits in eliminating the cancer, but also the emotional wellbeing of the
patient. In being able to explore some treatments that are familiar, the patient may feel
more empowered to take the control away from the illness, and the helplessness that
may come from taking a passive role in one’s healing.
Background of the Problem
The use of alternative or complementary medicine in the United States is
steadily growing. People are drawn to the simplistic and holistic ideals of using more
natural substances to cure the body. However, there is an unfound belief that because
the herbs are all natural, they cannot harm, only heal the body. Unfortunately, this is
not true. Just like medications produced in a lab, if herbal supplements are used
incorrectly, they may cause more harm than good. Alternative or complementary
medicine covers a wide range of options, from chiropractors, to herbs, to massage,
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acupuncture, acupressure, tai chi, qi gong, and may even include hypnosis and selfprayer.
The use of alternative medicine is steadily growing worldwide, estimating that
10 to 50% of the world’s population is now utilizing alternative medicine on a daily
basis. The use of herbal medicine has increased 380%. It is estimated that up to 50%
of cancer patients utilize alternative medicine to treat their disease; however, very few
inform their physicians of this use. Of this amount, 10% of patients choose to use
alternative medicine in lieu of mainstream treatments. There are several reasons why
people choose to use alternative medicine instead of conventional medicine, the main
reason being that conventional modes of treatment may be painful or unpleasant, or
tend to have a negative impact on a person’s quality of life (Kieu, 2002).
With the large increase of the use of herbs and alternative medicine, and the
reluctance of patients to inform their doctors, there come risks and dangers of drug
interactions. One example is there are herbs that may cause a patient to be overly
sensitive to light, which increases the harm of radiation treatment. Other herbs also
have anticoagulation effects on a person’s blood, which poses danger to a patient
during surgery. If a physician is unaware of the effects of the herbs, or of the patients’
use of the herbs, it is difficult to set a beneficial treatment plan for the patient.
Many people are not aware that their physicians need to be made aware of their
use of alternative medicines, therefore do not share this information. Some believe that
their doctors are not familiar enough about complementary medicine, therefore there is
no reason to inform them, and others do not tell their doctors because they are fearful
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that the doctors will discourage their continued use of alternative methods (Xu et. al.,
2006).
The main risk to oncology patients in utilizing herbs with conventional medical
treatment is the possibility of negative herb-drug interactions. This is even more of a
problem if the physician prescribing the conventional treatment is unaware of the use of
herbs, or the effects of specific herbs. If a physician is knowledgeable of the use of
herbs and their effects, then there can be closer monitoring of specific characteristics of
the patient (Shia, et al, 2004). The doctor can make well-informed suggestions for tests
and lab work to correctly monitor the patient’s health. If the physician is aware of an
herbs reaction with specific treatment, and it is shared with the patient, then this allows
the patient the opportunity to make a well-informed decision on how to go about their
own treatment of their illness. They can weigh the benefits and options of either
continuing to pursue Complementary Alternative Medicine (CAM) with or without
conventional treatment, or to forgo CAM and choose only conventional treatment.
Statement of the Research Problem
There is a lack of professionals within the medical setting that can broker
between the modern Western practices and the traditional Chinese medicinal practices.
With the possible benefits that traditional Chinese medicine has, and the large number
of people who use Chinese medicine without a doctor’s supervision, it will benefit the
medical profession as well as the public to have trained professional social workers
within oncology clinics to advocate for those who wish to choose alternative medicines
along with Western medical treatments.
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Purpose of the Study
The purpose of this project is to create a social work position within a cancer
treatment center to assist patients in their treatment by helping bridge the gap between
Western medicine and Traditional Chinese Medicine (TCM). The social worker will
have training in the use and benefits of TCM, to be able to inform patients of their
options. This will allow patients to make informed decisions about how to progress
with their treatment. One of the responsibilities will be to advocate to the doctors for
the patients’ choice to use alternative medicine along with their Western methods of
treatment.
The social worker will also have resources for TCM services in the Stockton
area to offer patients who are interested. The resource list will be updated annually to
ensure all the information is current. The social worker will participate in continuing
education pertaining to the use and benefits of Traditional Chinese medicine. One of
the resources will be an informational guide to TCM for oncology patients, which is the
second part of this project.
Theoretical Framework
The empowerment perspective states that an individual’s feelings of
powerlessness play a large role in an individual’s experience, and how they interact and
react to others. The term “empowerment” is described as the process of increasing the
personal, interpersonal, and/or political power. By doing this, it allows the individual
to take action in order to improve their life situation. This theoretical framework found
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its beginnings in community organization, adult education techniques, and feminist
theory (Gutierrez, 1990).
On an individual level, empowerment is the description of the development of
the individual’s feeling of increased power or control without any actual changes in
structural arrangements (Gutierrez, 1990; Pernell, 1985; Pinderhughes, 1983; Sherman
& Wenocur, 1983; Simmons & Parson, 1983a, 1983b). Through the process of
empowering oneself, the person develops a sense of personal power. There are some
psychological changes that appear to occur in individuals as they transition from a state
of apathy and despair to action (Gutierrez, 1990). One of these changes is described as
increasing “self-efficacy” which is an individual’s ability “to produce and to regulate
events in one’s life.” (Bandura, 1982, p.122). This is usually explained by examples of
people who seem to display a sense of personal power or strength that seems to increase
as they become more empowered. For many oncology patients, immediately after
receiving a diagnosis of cancer, there are extreme feelings of fear and a feeling that
they have lost control over their own lives, and their own bodies. This disease is
controlling their physical bodies, mind and lives.
Another psychological change is reducing self–blame. Some feelings that have
been linked to self-blame are depression and feelings of being immobilized. By being
able to reduce these feelings, and change patients’ focus from feeling helpless, to
feeling that they are able to change their situation increases feelings of control
(Gutierrez 1990, Garvin, 1895; Hirayama & Hirayama, 1895; Janoff-Bulman, 1979;
Keefe, 1980; Longres &McLeod, 1980; Pernell, 1885; Solomon. 1976). Some cancer
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patients may begin to question what it is they may have done to bring on this diagnosis
and suffering onto themselves. Some may blame the things they did to their physical
bodies; did they eat the wrong things, should they have quit smoking or drinking
earlier, should I have found a line of work that had better working conditions? Those
that may be more spiritual may believe that they have done something sinful or wrong,
and that the cancer diagnosis is punishment for their sinful deeds. By being able to
move out of this mindset, patients begin to be able to see that perhaps the disease is not
punishment and undeserved, this may assist them in being more open to suggestions
and healing.
Along with personal growth through the empowerment perspective, there is an
assumption of personal responsibility for change. By taking personal responsibility,
patients may be more likely to take an active role, and put more effort into improving
their lives and their health. This may cause patients to perform more research on their
illness and which options are available to them. By taking action, and personal
responsibility for their own health and well-being, they begin to take action against the
disease and become active participants in their treatment plans.
Another definition of empowerment is “the creation of an environment in which
individuals can behave as responsible adults, and where decision making is made at the
point where the knowledge is greatest.” (Williams, 2002, pp.100). Currently, in the
medical field, the nurses and doctors are working from the paternalistic model where
patients are expected to follow the directions of the doctor, who is seen as the
knowledgeable and unquestionable one in the doctor-patient relationship. By changing
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the model to one of patient empowerment, there are benefits to this relationship, and
may improve the patient’s experience with one’s doctor on five characteristics:
acceptance, which is used to describe the doctors’ need to accept the patient as they are.
Affect, which describes how the patient and the doctor respond to each other as the
partnership relationship evolves. Autonomy, which describes the patients’ right to play
as large or as small a role in the treatment as the patient wishes. Alliance is the
description of the partnership, and the relationship building between doctor and patient
that is supported by active participation by the patient (Williams, 2002). Patient
empowerment is not only important in the eyes of the patient, but also from the
healthcare professionals’ opinion as well.
Definition of Terms
Acupressure: Stimulation of points on the body by means of pressure, usually using
hands, fingers, and or thumbs (Beal, 2000).
Acupuncture: Insertion of thin needles to different depths at a variety of points on the
human body. It is a method to restore balance within the body, either by putting
energy into the body, or releasing energy through the use of needles (Beal,
2000; Simpson, 2003).
Cupping: the placing of heated, inverted cups on the skin to draw out stagnant blood or
Qi (Johnson, 1999).
Holism: The view of health as a positive state, conceptually combining the idea that
health does not just occur in a person’s physical body, but also in their mental,
emotional, and spiritual bodies (Cassidy, 1998).
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Qi or Ch’i: Is described as the vital air within the body, or the basic life energy or life
force (Mainfort, 2004; Beal, 2000).
Qi Gong: a physical and mental exercise, the manipulation of the regulation of the
body, breath, and mind into an integrative whole, with the breath as the key
regulator practice to make this happen. It is a form of Chinese energy control
therapy which is done through a process of relaxation, and entering into a
tranquil state using breathing techniques to optimize a health promoting cycle
(Shinnick, 2006; Johnson, 2001;Lee et. al, 2006) It is a conservative therapy
that is seen as a complement rather than an alternative to biomedicine (Simpson,
2003).
TCM: Traditional Chinese Medicine, includes the use of herbs, qi gong, acupuncture,
and acupressure (Burke et. al, 2003; Simpson, 2003).
Assumptions

Oncology patients would utilize a resource guide.

Patients want to include their Western doctor in their alternative care.

Patients enter into treatment for one of two reasons: to lengthen survival and
maintain high quality of life, or to maintain comfort and minimize pain.

During treatment, patients wish to experience as little discomfort or side effects as
possible.

If treatment is successful in reducing symptoms of cancer, patients want to reduce
the chances of reoccurrence, or increase amount of time between occurrences.
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
Patients wish to maintain high quality of life, and same level of physical or
emotional activity.
Justification
This project shall benefit the field of social work by upholding the National
Association of Social Work’s (NASW) Code of Ethics, as well as provide a much
needed resource within the medical oncology field. The position proposed in this
project will continue to uphold the core values of social work while providing a service
in the established field of medical social work. The value of service will be upheld
directly by the social worker providing direct service to clients within the cancer clinic.
Social justice will be served in that by advocating for patients’ rights to choose to be a
part of their own treatment, and to take an active role in their treatment plans, it allows
the patients to be equal decision makers along with doctors in their cancer treatment. It
also affords the rights of patients to utilize other forms of medical treatment either with,
or in place of conventional Western medicine.
This project will continue to value the dignity and worth of patients in that it
respectfully trusts that patients inherently know what is best for them, and it
understands the differences of medical treatment in different cultures and ethnicities. It
will allow patients to utilize methods each culture is accustomed to, and allow them to
combine this with Western medicine if that is desired. It will also be taken into
consideration that this work is only possible if the patient is willing, and will take an
active role in learning and utilizing the alternative methods. By respecting patient’s
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wishes, it will help to strengthen the patient-doctor relationship, and promote a
healthier line of communication.
This position will also uphold the integrity and competence values as continuing
education as well as supervision will play a large role within this project.
Limitations
1.
Limited to the Stockton area
2.
Information on TCM limited to the time of the research. New developments may
occur at a later time.
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Chapter 2
LITERATURE REVIEW
Introduction
The diagnosis of “cancer” is a life changing moment in many patients’ lives.
Though cancer itself is so prevalent in our time, individuals and families are usually in
disbelief when they hear this term referred to someone in their lives. Many of the
initial feelings associated with a cancer diagnosis consist of loss of power, control,
feelings of helplessness, uncertainty, and fear.
However, for several, their fight response takes over, and instead of wanting to
sit by and let doctors dictate their path of treatment, many people are choosing to find
their own paths of treatment. One of the choices patients are turning to is
complementary medicine. Complementary medicine is the term used to describe
diagnostic and therapeutic disciplines that are used together with conventional
medicine. There are several personal reasons why patients are choosing
complementary medicine for treatment. Some choose to forego traditional Western
medicine because they feel they are doing more harm than good, or they may have
gotten a poor prognosis from Western doctors and have set out to find cures for
themselves. Others choose complementary medicine because the idea of a more
holistic approach is more appealing to them.
Whatever the reason, many more patients are looking to explore utilizing or
incorporating more complementary techniques with their oncology care. For medical
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social workers, this is important to understand in order to fully support our patients, and
advocate for their choice to use more holistic medicine. For this reason, a brief look at
the medical model, as well as a look into medical social work will be examined.
Literature for Traditional Chinese Medicine will also be explored; some of the more
common techniques and uses will be studied. A look into its history and most common
forms will be discussed, as well as several of the reasons patients may look towards this
form of medical treatment.
History of Medical Social Work
Medical social work has been a part of the health care system for about 100
years. It was not until the year 1905 that social work in a medical setting existed. The
conception of medical social work took place in Massachusetts General Hospital.
Richard Cabot MD, who was the director of Massachusetts General Hospital at the
time, recognized the importance of a holistic approach to medical care. To him, this
included meeting the psychosocial needs of patients as well as their medical needs. The
doctor recognized the importance of continuity of care for patients. In order to meet
this need, Dr. Cabot hired Garnet Pelton to provide social work services. The original
office was made up of tables and chairs set up in a small area, and was employed by
thirteen volunteer assistants (Ross, 1995; Galambos, 2005).
The first hospital social work department was established one year later. Ida M.
Cannon was put in charge of the development of the new department whose primary
purpose was to ensure that the patients’ progress they had gained while at the hospital
was continued in their homes. The task of the social workers was to provide services to
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aid patients in making a smooth transition between the hospital and the community
(Bartlett, 1975; Galambos, 2005).
Medical Model
The medical model is the dominant approach to illness and treatment within the
Western culture. It is a clear set of guidelines that most medical professionals use to
treat patients, and the focus is on treatment of symptoms and syndromes of an illness.
This point of view sees the human body as a very complex mechanism, and seeks to
find the causes of specific syndromes within the human body. This framework tends to
focus on the patient’s body, and there is a distinct separation of the body from the mind
and spirit of the individual (BFI, 2007). The professionals begin to view the patient in
terms of their illness or symptoms, and fail to see the individual as a whole person.
This model tends to focus on the individual’s physical illness, and on physical
treatments (Haslam, 2001). Treatments for illnesses under this model are a result of
information of what has worked best for the majority of people, usually in clinical
trials.
Within the medical model, the authority lays within the physician, for this is the
person who gives the medical orders, and it is presumed that the doctor knows what is
best for the patient. Although there is teaching done for the patient, the idea is that the
physician is in charge of the patient’s care (Riolo, 2004). This differs from the holistic
point of view, which says that the patient knows what is best for them, and is in charge
of their own treatment. The physician is in the helping role (Barrett et. al, 2000).
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History of Traditional Chinese Medicine
Within the last twenty-five years or so, there has been an increased interest in
holistic health care in the United States. Chinese medicine itself is over 2000 years old,
one of the oldest forms of medicine, and has several modalities of treatment such as
acupuncture, herbal treatment, and exercises such as Tai Chi and Qi Gong. In the
United States, TCM is recognized by the National Institutes of Health as effective
complementary and alternative medicine. It is now widely used by consumers, and
continues to grow as a profession (Burke et al., 2003).
An important concept of TCM is the idea of “Qi” or “Ch’i” which describes the
belief of vital air within the body. It is also seen as the basic life energy or life force
within the body. Health is seen as a state of balance. Qi is said to flow through the
body in channels, which form interconnected pathways. If a pathway is blocked, the
result may be illness or discomfort, or other malfunction within the body. Many of the
modalities of Chinese medicine believe that illnesses are the result of an imbalance of
Qi within oneself, instead of a “disease.” The goals of TCM are to re-harmonize the Qi
within the body in order to control and maintain a healthy body, mind, and spirit (Beal,
2000; Cassidy, 1998; Mainfort, 2004, Xu et al., 2006). The belief is that each
individual is different. In order to accurately treat a patient, the practitioner must
closely observe the movement of Qi within each individual. It is believed that patients
can avoid much of the malfunction within their bodies by learning techniques to keep
the Qi flowing smoothly (Cassidy, 1998).
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Many practitioners see commonalities between TCM and modern medicine.
For example, cancer is seen as a stagnation of blood and Qi. Modern medicine views
this as abnormal vascular supply, blood stasis, and poor oxygenation in the body.
While Western medicine would treat this with anticoagulation therapy, TCM would
utilize destagnation herbs (Ghayur, 2009).
Different Forms of TCM
Acupuncture and Moxibustion. Some of the more widely known and utilized
modalities of TCM include Chinese acupuncture which is the insertion of thin needles
to different depths at a many variety of points on the surface of the body in order to
reroute the flow of Qi within one’s body. The placement of needles is based on a
systematized, complex and sophisticated theory (Beal, 2000). Only a trained
professional should do acupuncture. The placement of the needles is also dependent on
the symptoms that are present. For example, the placement of needles for nausea may
be different for headaches or low libido. Specific acupuncture points affect the
functioning of specific organs, though these points may not be close to the actual
organ’s anatomical position. There are approximately 500 points on the body, and a
select 10 to 12 points are chosen for each treatment. Different points can be chosen,
and can be changed during a course of treatment (Mason, 2008).
Commonly, acupuncture is used in conjuncture with moxibustion, which is the
burning of a preparation of the herb Artemisia Vulgaris, in a way where the heat
stimulates the underlying point on the body. Moxibustion or acupuncture are seen as
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complementary, though one may be emphasized or seen as more appropriate depending
on the particular situation in which treatment is being sought (Beal, 2000).
Acupressure. Acupressure is the stimulation of the points on the body, by
applying pressure, usually using hands, fingers, and thumbs. This can be performed on
another person, such as from a professional to a client, or it can be performed by
oneself on those points of the body that can be reached (Beal, 2000). It is beneficial to
learn the basics of acupressure before performing it, in order to maximize the benefits.
One can learn which points on the body effect which body systems.
Qi Gong. Another growing area of TCM is the concept of Qi Gong. Qi Gong is
a form of Tai Chi, which is better known in Western culture. Tai Chi is known as
“meditation in motion.” Its slow motion, and low impact movements characterize Tai
Chi. Many of the movements are named after animal actions or martial arts moves. As
the movement is performed, the individual is breathing deeply, and naturally, and the
person’s attention is focused solely on the body’s sensation. This is the core of Tai Chi,
the “mind-body” connection. One of the benefits to Tai Chi and Qi Gong is that the
movements are not difficult, are usually circular in motion, and not meant to be forced
(“Health Benefits”, 2009). This is a benefit to oncology patients because this form of
exercise does not require a person to be in perfect health, but can be adapted for any
individual, and for what their body is able to perform.
Qi Gong as a form of exercise has been steadily growing in popularity, as the
benefits are becoming widely known. Qi Gong is described as both a physical and
mental exercise. The basis of this exercise is to manipulate the regulation of the body,
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breath, and mind. The goal is to integrate all these components into a whole, and
utilizing breathing as the key to regulate all these aspects (Shinnick, 2006). Qi Gong
can work directly on a patient’s central nervous system, and the sympathetic nervous
system through a process of relaxation, going into a tranquil state, and breathing. This
can improve the patient’s emotional state, which in turn will optimize the person’s
physical and biochemical functions, which can put the individual into a healthpromoting cycle. The actual exercises can be amended to accommodate what the
patient is physically able to perform, though they are non-strenuous exercises to begin
with. The types of exercises can be tailored depending on the type of cancer that it is
meant to treat. The benefits of this exercise has been studied and found to ease the pain
and discomfort that chemotherapy patients experience. There is improvement in both
the physical and emotional wellbeing of oncology patients. (Lee et al., 2006; Simpson,
2003).
Herbs. The use of herbs is also a popular component of TCM. The category of
herbs may include botanicals, minerals, as well as dried animal parts. Typically, a
practitioner will prescribe a combination of the herbs depending on the individual
patient’s ailments. Historically, the herbs come in its raw form and are then boiled in
water, extracting the healing components into tea form. The tea is then drunk by the
consumer. This can be a time consuming process, and the results may be unpleasant
tasting to drink. Herbs should only be purchased from those knowledgeable in the
differences and results of each herb, similar to Western pharmacists. Today, herbs
commonly come in tablet, pill or liquid form for the convenience of the patients. The
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herbs are freeze-dried, or other extraction methods, then formed into easier to swallow,
and less time consuming forms (Ko, 2006).
Although there currently is very little research on the effects of TCM, that is
slowly changing. In Hong Kong, there currently is a ten-year plan in place, where the
government is currently funding eighteen TCM research projects, which will include
clinical trials. Their goals include developing quality standards and conducting
pharmacological studies in new research labs. Though TCM is still a long ways away
from being accepted in the mainstream of a conventional medicine, efforts are being
made (Normile, 2003).
Benefits, Reasons for Choosing TCM
For cancer patients, there are several benefits that are mentioned when utilizing
an integrative health care approach. Patients have reported to having more energy, as a
common complaint of cancer treatment is a feeling of being drained or feeling low on
energy. The result of the integrated health care has been an increase of energy “to deal
with the different issues in my life” (Verhoef et al., 2005, p. S-62.)
Holistic Care. One of the main benefits that have been stated for using TCM is
its holistic approach to healthcare. The idea behind “holism” is that the main focus is
not simply on a person’s physical body, that illness does not affect just the physical
form. A person’s illness affects all aspects of a person, including their mental,
emotional and social states. Therefore, treatment for illnesses should not focus on the
physical form, but should address all the affected areas of an individual. The holistic
concept also argues that an individual must take some responsibility for the creation of
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one’s ill health, therefore should also take responsibility for the alleviation of the
illness. The physician, or practitioner acts as more of a facilitator in this change, but
the patient can also affect change in his or her health status by changing their own
actions and attitudes (Cassidy, 1998; Abdullah et. al, 2003).
Other benefits of TCM that have been reported by users include the relief from
physical as well as emotional pain. They report that they feel an increase of “energy”
or “quip,” that it can induce calm and relaxing sensations, without the reliance on
prescription medications. With the use of TCM, there is an increase of self-awareness
with a sense of wholeness, balance, centeredness and well-being, and increases the
feeling of self-efficacy. The findings were that people were more connected to their
physical bodies, more aware of where the pain and discomfort was, but that they also
felt freer because they did not have to rely on medications to relieve ailments; they had
control over their own bodies. TCM has also been found to be helpful when used
together with traditional Western medicine. Women undergoing chemotherapy for
breast cancer reported improvement in their symptoms of side effects from the
chemotherapy, as well as improvement of psychological distress from chemotherapy
(Lee, 2006). There is often a belief that the use of Traditional Chinese Medicine along
with Western medicine aids to improve one’s quality of life overall.
Many feel that Western medicine, though necessary to fight the cancer, is
harmful to the body. After chemotherapy, Chinese medicine is used to adjust the body,
to re-center it. Patients have felt that by utilizing alternative medicine, they felt
stronger and were more able to participate actively in their Western medical cancer
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treatments. The findings do not show that the majority believed that alternative
medicine was more superior, and that most patients comply with the conventional
methods of cancer treatment (Abdullah, et al., 2003). Qi Gong is seen as energy
healing and is seen as a way for the body to recover from the treatment, and as a way to
prevent the cancer from recurring (Simpson, 2003).
Self Care. Patients have reported that they choose to use alternative medicine in
conjunction with modern medicine because they feel that both together work better than
each one alone. They also chose to include alternative medicine because patients felt
they could participate more actively in their treatment. There was a feeling that more
orthodox treatments did not provide patients with enough of a sense of control over
their own health; alternative medicine is able to play a supplemental role in filling the
gap (Abdullah et. al, 2003).
When patients decide to explore the possibility of using TCM, they go through a
process of self-help. This happens when patients choose to obtain more information
about TCM cancer therapy by gathering information from several resources. Usually,
family, friends, other patients, and support groups become main resources for
information. Oftentimes, patients have utilized TCM in other aspects of their lives, and
have had positive responses. This is when they choose to incorporate TCM into their
cancer treatment as well (Xu et al., 2006).
Pain Relief and Control. A main goal for pursuing TCM or other
complementary alternative medicine treatments is to control, and manage pain. Some
wish to find ways to manage pain without as many pain medications, and others wish to
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be able to function again without being crippled by pain. Patients wish to find meaning
in their lives again separate from their cancer diagnoses, and see TCM as a venue to the
possibility of returning to previous levels of active living. Individuals wish to be able
to perform activities for pleasure and enjoyment again, which may have not been
possible without TCM (Verhoef et al., 2005).
Relief from physical pain is the main reason why a majority of patients turn to
TCM initially. Many patients turn to this option after they have tried more
conventional, Western methods of treatment. Studies have been done to test how some
forms of TCM have benefited oncology patients. Robertshawe (2008) discusses
research done on a study utilizing acupuncture, and acupressure and its affects on
cancer related fatigue. Their short-term results show that acupuncture and acupressure
both may assist to alleviate the fatigue felt by patients after chemotherapy.
Aside from relief of physical pain, patients have also found that TCM relieves
or decreases emotional pain. There is relief from stress, and a newfound freedom from
the constraints that illnesses may hold a patient in. TCM can create sensations of
calmness and relaxation. Patients have found that consistent use of TCM may also
decrease the frequency, intensity or duration of chronic complaints, either as side
effects to treatments, or chronic illnesses (Cassidy, 1998).
Other consumers have also turned to TCM as a way to reduce reliance on
prescription medication as a way to relieve symptoms. This can give a sense of control
back to the patient, and take away to need for medication. Western medicine does not
give patients enough of a sense of control over their own health, TCM is able to
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alleviate this feeling of a loss of control (Abdullah, 2003). Consumers have also
reported that the use of TCM can speed healing after surgery, or can strengthen the
immune system, reducing the frequency of common illnesses such as colds (Cassidy,
1998).
Improved Provider/Patient Experience. For those patients who choose to utilize
TCM, many do not share this information with their treating doctors, because they feel
that their doctors will not understand or approve. Instead of jeopardizing the
relationship with their healthcare providers, patients may choose to withhold this
information. It is found that one-third of the population use alternative therapies, but
many do not discuss this with their doctors (Eisenberg et. al, 1993; Simpson, 2003)
Another benefit that has been stated in the literature for the use of TCM is that
there is an improvement in the experience that patients have with their health care
providers. Due to the personal nature of the use of Traditional Chinese Medicine, this
encourages more personal conversations between patients and doctors. By
incorporating the use of TCM, patients stated that they did not feel their doctors were
dictating their treatment, but that they had a more horizontal relationship with them,
working with them on their treatment. Patients get a feeling of more “hands on care”
from their providers. Many patients choose to use TCM “because the staff listens and
offers encouragement and support” (Burke et al., 2003, p. 1083). In order for holistic
care to be beneficial, the practitioner needs to know his or her patient very well.
Because it is believed that each individual is different, there are no set protocols for
treatment of illnesses. Each practitioner sets different orders for individual patients.
24
Different combinations and doses of herbs depend on the patient, the symptoms, and
the assessment of the practitioner. Part of the trust between patient and practitioner,
and in TCM itself, is related to, and dependent on the respect for individual situations
and wishes. The practitioner and patient establishing close, peer relationships, and
acting together to treat the illness reach holism. Hands on care, and treatment of the
whole person requires that the practitioner listen carefully to the patient, and offer
suggestions or education on how the patient can take control within their lives to
prevent reoccurrence of symptoms, enhance their health or redirect their own lives
(Cassidy, 1998; Xu et al., 2006).
Conventional Western doctors have been described as often being
disempowering towards patients. Doctors may come off as condescending,
disparaging, chauvinistic, or coming off as too authoritative. Those practitioners of
alternative medicine were often characterized as facilitating in the healing process,
rather than directive. They tend to rely on the self-empowerment and the personal
responsibility of the patient for restoration of health. TCM requires the patient to be a
part of it in order for it to work (Barrett et. al, 2000).
There are many reasons why consumers choose to use TCM; some reasons
include the relatively low cost of the herbs when compared to Western medications.
Others feel that there are fewer side effects, and less long-term negative effects.
Consumers also feel there is a higher chance of longer term effect of recovery, and less
of a chance of recurrence of illness as it is more healing-oriented, where the focus is on
25
activation of the natural reserves within the body, and rebuilding of the resistance of
illnesses (Xu et al., 2006).
Empowerment. Many patients are turning to alternative forms of medicine
because of the feeling of control that they are able to gain from alternative practitioners.
There have been comments that conventional practitioners tend to “phase out” when
patients attempt to discuss issues with them. Others have made statements that they
feel traditional Western practitioners have a tendency to “take over” the care of the
patients’ illnesses (Barrett et al., 2000).
With alternative medicine, practitioners work with the patients, letting the
patient lead their own treatment. The role of the practitioner is to assist and work sideby-side with the individual as they heal themselves. Alternative healers see the
importance and the benefits of empowering a patient to treat themselves (Barrett et al.,
2000).
Toofany (2006) writes that the simplest form of empowerment is to give an
individual the opportunity to choose, and to act on those choices. This is one of the
most basic principles in allowing patients to choose to use alternative medicine in their
cancer treatment. The simple act of taking control of their illness, and choosing how to
go about their treatment, helps them to overcome the helplessness they feel when they
are diagnosed with cancer.
Education
Because of the large portion of the population that chooses to include Chinese
medicine and complementary medicine, there is a great need for education for the
26
general public in this area. There are several dangers that the uneducated TCM
population is at risk for, especially if they are being used along with bio-medication. If
a prescribing doctor is unaware of the herbs or supplements a patient is taking, s/he
may prescribe medication that may have adverse reactions when used with the herbal
supplements (Shia, 2004). Many patients choose to use TCM but do so without
involving their Western medicine care givers. Very few who utilize TCM report a
supportive attitude from their conventional caregivers about their alternative choices
(Xu et al., 2006).
There is a common belief that TCM is considered “safe treatment”, which is a
popular reason why many choose to use this route of treatment. In the study done by
Xu et al. (2006), it is reported that all the participants agreed that TCM does not cause
any adverse effects. Though this may be true for some, patients still need to be
informed and educated on the importance of utilizing TCM under a trained practitioner
who is aware of the other medical issues and medications the patient may be using.
Herbs should be treated just like prescribed medications from a medical doctor. They
may have side effects, and may interact with other medications in the body.
Due to the growing popularity of TCM in Western society, physicians and
medical staff need to be educated on the benefits and risks of herbs. In the East, there
have been several studies done to show the many benefits of TCM. There is little
education available to both practitioners and consumers in Western countries (Xu et al.,
2006). Due to the philosophical and old worldview of TCM, many physicians are not
accepting of this form of treatment for illnesses and symptoms.
27
Exercising Caution when Utilizing TCM
Some hesitation over utilizing herbs may be that there is a belief that there is no
regulation in the U.S. However, it should be known that herbs are a closely monitored
import. Consumers should be aware that herbs in the U.S can be considered a drug, if it
is used for treating or preventing diseases, as food if it is to be used for its taste,
nutrients or flavor, or as a dietary supplement when it is used to maintain health. Under
the current federal legislation that regulates herbal products known as the Dietary
Supplement Health and Education Act (DSHEA) of 1994, all herbal products are
considered food products under the category of dietary supplements. TCM products are
usually classified as such. TCM herbs also fall under the jurisdiction of the Food and
Drug Administration (FDA), U.S Department of Agriculture (USDA), U.S Fish and
Wildlife Services (FWS), U.S National Marine Fisheries (NMF), U.S Environmental
Protection Agency (EPA), U.S Customs, state agencies, and local health departments.
Consumers should also be aware that all dietary supplements require labeling that
includes supplement facts, directions of use, and name of the manufacturer, distributor
or importers. If a label does not contain these items, it may be indicative of counterfeit,
or illegally imported. Patients should be mindful of where they purchase their herbal
supplements. All legal importers should have certificates of analysis or vouchers that
show their products comply with the manufacturer or importer specifications. If one is
buying from a non-reputable vendor, consumers run the risk of the herbal products
being substituted, misidentified, mislabeled, or contaminated (Ko, 2006).
28
Within our society, there is a great need for regulation and monitoring of the
usage of TCM. There are risks when untrained professionals administer TCM.
Complications such as burns from cupping or punctured lungs from improperly placed
acupuncture needles are possible, and have happened (Johnson, 1999). Certain safety
measures should be used, some areas of consideration include: the right dosage, caution
when using herbs for extended periods of time, herb-drug interactions with other
medications, good manufacturers of the supplements, and contamination. All use of
complementary medicine should be discussed with your treating physicians before
starting any new regimen. (Ghayer, 2009).
There is a growing interest in an integration of TCM with Western medicine.
Though there is little research done on this subject, Wong et al.’s (2006) study of
Chinese fourth year medical students in Hong Kong state that the students are interested
in learning about the integration of the two theories. There is a feeling that they can
take the strengths from each discipline, and maximize the benefits for patients.
However, the students are feeling that more education is needed, and that there seems
to be a rift between the both sides that are not allowing them to come together. The
students would like more guidance and education when and how it would be
appropriate to incorporate TCM with Western medicine.
Though it is clear that there is popular interest in complementary medicine in
general, it is still in its new stages here in the U.S. As it begins to grow in popularity
within the general public, and with oncology patients, it is important that patients have
access to information and support when choosing this course of treatment. It may be
29
difficult to argue some of the medical beneficial treatments from TCM as it is still
being studied; there is little doubt of the psychological benefits to oncology patients.
Among medical professionals, it has been clear that patients benefit psychologically
and spiritually when they feel in control, and a part of their medical treatment.
Choosing to utilize complementary medicine in their treatment and being able to take
back the sense of loss of control from their illness may be just the stepping-stone that
cancer patients need.
30
Chapter 3
METHODS
Research Design
The design for this project consists of a qualitative, exploratory study format.
Grounded Theory was used to guide this project because it does not use statistical data.
Grounded Theory was chosen because it allows the researcher to be open to changes in
the initial research question, allowing their collected data to guide the project. This
theory utilizes themes and commonalities in the research for analysis (Kreuger &
Neuman, 2006). Literature on Traditional Chinese Medicine and cancer treatments was
reviewed for guidance in the direction of the project.
A questionnaire was developed, and distributed to a group of medical
professionals in an oncology setting, and professionals who work within the field of
Traditional Chinese Medicine. The results gathered from this project are not meant to
persuade individuals into making decisions, either for or against the use of TCM, but to
help create a guide that will give individuals more information on the topic of
Traditional Chinese medicine and oncology care, and to show a need for support of a
patient’s choices, and feeling of control over their diagnosis and treatment. The guide
is not meant to persuade patients into any decision.
Subjects
Individuals considered for this project are medical professionals, and
individuals who are familiar with Traditional Chinese medicine. Recruitment of
31
individuals was done by requesting personal friends and professional colleagues whom
are known to have medical or Traditional Chinese Medicine experience to complete the
questionnaire and for a brief interview of their experiences.
The subjects were found through 2 methods. The first method was through
word of mouth of present and past colleagues in the medical field. The second method
was through having participants ask co-workers if they would be willing to participate.
Instrumentation
The instrument used in this research project was a 7-question questionnaire that
asks individuals to list their observations and experiences with working with oncology
patients, and brief interviews with these individuals. It asks for their opinions on the
risks and benefits they may have observed with the use of TCM, how age, gender,
cultural, and spiritual beliefs affect a patient’s care, and how they have observed family
support to affect patient care, and handling of their diagnosis.
The questions are meant to be open-ended, leaving room, and encouraging
participants to describe their experiences with providing oncology care to patients. No
quantitative data will be provided, as the goal was to explore the individual’s
observations and experiences. Participants were chosen based on their profession in the
oncology field, or experience in utilizing Chinese medicine. The questionnaire can be
found in Appendix A.
Data Gathering Procedures
This study focused on the opinions of the subjects based on responses on the
questionnaire. Each individual was approached personally, either in person, by phone,
32
or email and asked to participate in the project. The purpose of the project was
explained, and contact information for the researcher was provided for those who were
interested in contributing. Once consent was given, and any questions the participant
had were answered, the questionnaire was given to the individual. Questionnaires were
distributed in person, or by email, depending on preference of the participant. Some
individuals were unable to meet in person for interviews. These individuals were
interviewed by phone and questionnaires were completed and returned by email.
Consent was given verbally and by mail. Some individuals declined to be interviewed,
but agreed to complete the survey. The procedure of open/axial coding was used to
analyze the collected data, a method of organizing data by choosing themes or codes
(Kreuger & Neuman, 2006). For the analysis process, the answers to the open-ended
questionnaire were compared.
Methodological Limitations
Some limitations associated with this study come from the methodology. The
main limitation comes from the sample used. The population size was small, compared
to the size of the population. The information that was gathered could not be used to
generalize the population at large. Due to the qualitative design of this project, it does
not contain random sampling, or large numbers of participants.
There was some difficulty, in that 2 medical doctors, who had originally agreed
to complete the survey, decided to drop out once they received the questionnaire.
Several reasons were given such as: too much paperwork, or uncomfortable with the
topic due to lack of knowledge.
33
Protection of Human Subjects
A request was submitted for review by the Committee for the Protection of
Human Subjects, and approved by California State University, Sacramento as “No
Risk” by the Division of Social Work. Confidentiality and anonymity was protected by
the fact that no personal information was gathered from the subjects. The only personal
information on the questionnaire is what the individual’s profession is. All data
collected was destroyed upon the completion of the project.
The research was explained to all participants, and how their information and
observations would contribute to the production of the resource guide. An informed
consent form was included with the questionnaire clearly dictating the reason for the
project, as well as how the information provided would be used (Appendix B). All
completed questionnaires and signed consent forms were kept in a locked box, and
destroyed upon completion of the project.
34
Chapter 4
FINDINGS
Introduction
Upon receipt of the questionnaires, and completion of the interviews, the
researcher analyzed the data gathered. From this analysis, three main themes were
discovered. Those themes were 1) Empowerment includes knowledge, support,
information, and sense of control 2) Cultural and spiritual beliefs and practices play a
large role in how a patient and family deal with the prognosis of disease 3)
Complementary medicine is widely used by cancer patients 4) Complementary
medicine is beneficial when used by oncology patients. The following is a description
of the subjects who participated in the study, and a discussion of the themes resulting
from the questionnaire.
Description of Participants
A total of seven questionnaires were completed. Each subject is either a
medical professional in the oncology field, or utilizes Traditional Chinese Medicine in
some form to treat cancer patients.
The subjects are four oncology nurses, one a clinical nurse specialist. They
work specifically in an oncology clinic. Another is a radiation therapist who also works
within the same clinic. Another subject is a medical social worker, who works the
majority of the time with oncology patients. The last is a Qi Gong instructor who
teaches Qi Gong exercises to people with cancer.
35
Themes
Table 1 Core Themes
Subjects
Empowerment
includes:
knowledge,
support,
information,
sense of control
Cultural &
spiritual beliefs
and practices
play a large
role in how
patient &
family deal
with prognosis
Complementary
medicine is
widely used by
cancer patients
Complementary
medicine is
beneficial when
used by cancer
patients
1
2
3
4
5
6
X
X
X
X
X
X
7
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Empowerment
A recurring theme throughout the questionnaires seems to be the components of
empowerment. Mainly, it appears the most important component is information and
knowledge about their diagnosis and treatment. Subject 4 stated
I believe that patients who understand what’s happening and have a say in their care do
better. With an informed person, they understand that they have some choices, even
though they may be tough, unwanted choices.
36
The majority of the subjects state that more information and education is necessary for
patients to feel stronger, and able to face their treatment.
Cultural and Spiritual Beliefs
The cultural and spiritual beliefs of a patient and their family play a large role in
how patients choose to approach their treatment. In some cultures, the decision for
treatment is a decision made by the family, and not just the individual. Subject 2 states,
“Hispanics tend to make decisions as a group, rather than the individual patient making
choices.” Subject 3 writes, “Depending on patient’s spiritual beliefs, it can affect their
care. Some patients are welcoming of death, while I find others who pray for
miracles.” It is also important to include a patient’s family in their treatment, as many
times, the cancer affects all members. Subject 7 writes “Families are extremely
important and as an oncology nurse, I see that we need to treat the patient as well as the
family in teaching and supporting them.”
Use of Complementary Medicine
Out of the seven subjects, five have witnessed, or had patients who used
alternative medicine. The most common form of TCM used is acupuncture. Subject 1
states “I have seen patients get pain relief with acupuncture and meditation.” Others
have witnessed patients use Tai Chi, or acupressure. Subject 4 had a patient who “used
herbs in tea” along with their cancer treatment.
Benefits of Complementary Medicine
Those subjects that have observed patients who have used complementary
medicine, most of them say that it has been beneficial to treatment and morale. Subject
37
2 states that by using complementary treatment, “They feel empowered with ‘doing
something’ natural to aid in their recovery.” Others state that simply choosing an
aspect of their treatment, and taking an action gives a feeling of control. Medical
benefits have also been observed, but it is difficult for the subjects to say whether it is
due to the conventional treatment, or to the complementary course of medicine.
Through the data gathered from the participants, it is found that many oncology
patients are pursuing complementary medicine. Though it is difficult to say whether
the medicine itself is beneficial in the medical sense, it is the view of several of the
participants that the use of complementary medicine can be psychologically beneficial
for their patients. There is a sense of empowerment for the patient, and their families
when they are able to choose an aspect of their cancer treatment. It is also beneficial to
patients when they have family support, and strong spiritual and cultural beliefs during
this difficult time. The most powerful tool needed for patients during their course of
treatment, is a positive attitude, and an inner feeling of strength; however they can
achieve this goal is considered a positive.
Project Results
Resource Guide
Introduction. Hearing the word “cancer” spoken by your doctor can be one of
the most frightening, and life-altering events that a person, or a family can experience.
Being diagnosed with cancer may make you feel as if there is a clock ticking away
loudly, or that control over your own life has been taken away. You will certainly need
some time to adjust, and understand your new diagnosis. There may be several ways
38
you want to deal with this news. How you approach it may depend on the type of
cancer, or the prognosis you have.
One approach that is growing in popularity is combining Traditional Chinese
Medicine (TCM) with the more conventional Western medicine your doctor may
suggest. There are several benefits to using Traditional Chinese Medicine. Perhaps
you have heard of some, and that is why you are reading this at this time. Hopefully,
this guide will be helpful in providing some basic information about what TCM is, and
how it may be helpful for you in your situation.
Medical Model. Before you can understand how Traditional Chinese Medicine
differs from, and can work together with conventional Western medicine, you must first
understand what each of these are. Conventional Western medicine is based on what is
known as the “medical model”.
The medical model is the dominant approach to illness and treatment within
Western culture. The model consists of a clear set of guidelines that most medical
professionals use to treat their patients, the main focus being on the treatment of
symptoms and syndromes of an illness. This model views the human body as a very
complex mechanism, and seeks to find the causes of specific syndromes within the
body. The focus is on the patient’s body, and sees a distinct separation of this body
from the mind and spirit.
The health professional tends to focus on the patients’ physical illness, and on
physical treatments. Treatments for illnesses under this model are a result of
39
information of what has worked best for the majority of people, usually obtained in
clinical trials.
Within this model, physicians are the authority; they are the ones to give
medical orders, and are presumed to know what is best for their patients. Although
there is teaching of the patient involved, the physician is in charge of the patients’ care.
This differs from the holistic point of view, which sees the patient as knowing what is
best, and who is in charge of their treatment.
History of Traditional Chinese Medicine. Chinese medicine has been in
existence for over 2000 years; however, it is not until about the last 25 years that it has
been gaining in popularity within the United States. In the United States, Traditional
Chinese Medicine is recognized by the National Institutes of Health as effective
complementary and alternative medicine. It is currently widely used by consumers, and
continues to grow as a profession. Traditional Chinese Medicine, or TCM, differs from
Western medicine in that it chooses to treat the person as a whole, whereas Western
medicine tends to separate the body and mind.
TCM treats the person holistically by incorporating and treating a person’s Qi,
or “vital energy” which is central to a person’s body, mind, and spirit. The basis of
treatment is to intervene into the Qi, in order to make change within a person’s physical
state. “Qi” is the main concept of TCM. It is seen as the basic life energy, or life force
within the body. Health is viewed as a state of balance of Qi. This life energy is said to
flow throughout the body in channels, which form interconnected pathways. If a
40
pathway is blocked, the result may be illness or discomfort, or another malfunction
within the body.
The goals of TCM are to re-harmonize the Qi within the body in order to control
and maintain a healthy body, mind and spirit. The belief is that each individual is
different, and in order to accurately treat a person, the practitioner must closely observe
the movement of Qi within each individual before beginning treatment. It is thought
that people can avoid much of the malfunction within their bodies by learning
techniques to keep the Qi flowing smoothly.
Different Forms of TCM. There are several different forms of TCM. What
follows are some descriptions and information about a few of the more popular and
widely used.
Acupuncture and Moxibustion. Only a professional should perform this type of
TCM. Acupuncture is the insertion of thin needles to different depths at a variety of
points on the surface of the body in order to reroute the flow of Qi within one’s body.
The placement of needles is based on a systematized, and complex theory, as well as on
the symptoms that are present. For example, where the needles are placed for treatment
of a headache will be different for treatment of a low libido, or inability to sleep.
Acupuncture is commonly used with Moxibustion, which is the burning of a
preparation of the Artemisia Vulgaris herb, in a way where the heat stimulates the
underlying point on the body. Moxibustion or acupuncture are seen as complementary,
though one may be emphasized or thought to be more appropriate depending on the
situation, or the goal of treatment.
41
Acupressure. Acupressure is the stimulation of points on the body, by applying
pressure, usually done by using hands, fingers, and thumbs. The benefit of this form is
that it can be done by another person, like a professional, to a client, but it can be also
done by yourself onto those points on your body that you can reach. It is very
beneficial to learn the basics of acupressure before performing it, in order to get the
maximum benefits. Different points on the body effect different body systems.
Qi Gong. Qi gong is a form of exercise that is growing in popularity, as the
benefits are becoming widely known. It can be described as both a physical and mental
exercise. The basic concept is to manipulate the regulation of the body, breath, and
mind. The goal is to integrate all of these components into a whole, and use breathing
as the key to regulate all of these aspects.
Qi gong can work directly on the central nervous system, and the sympathetic
nervous system through a process of relaxation, and breathing. This can improve your
emotional state, which will optimize your physical functions that can put you into a
health-promoting cycle. The actual physical exercises can be amended to
accommodate what each individual is physically able to perform, although they are
non-strenuous exercises to begin with.
The exercises can be customized depending on the type of cancer that it is
treating. The benefits of Qi Gong have been studied and found to ease pain and
discomfort that is experienced with chemotherapy. There is improvement in both the
physical and emotional wellbeing of oncology patients.
42
Herbs. The use of herbs is another popular component of TCM. Herbs may
include botanicals, minerals, and dried animal parts. A practitioner, who will decide
what type and kind of herbs to use depending on the individual patient’s ailments,
should prescribe the combination of herbs used. Herb combinations should only be
purchased through those who are knowledgeable in the differences and results of each
herb, similar to purchasing Western medication through reputable pharmacists.
In the past, the herbs in its raw form are boiled down using water, extracting the
healing components. Then the consumer drinks the herbs in this tea form. This can be
a very time consuming process, and the results are usually unpleasant tasting to drink.
Today, herbs can commonly be found in tablet, pill or liquid form for the
convenience of consumers. These herbs are freeze-dried, then formed into easier to
swallow, and less time consuming forms.
Benefits or Reasons for Choosing TCM. There are several reported benefits and
reasons why cancer patients tend to choose using TCM with their Western oncology
treatment. Many of the reasons tend to give consumers back a sense of control over
their own bodies and illness. There are many reasons why consumers choose to use
TCM; some reasons include the relatively low cost of the herbs when compared to
Western medications. Others feel that there are fewer side effects, and less long-term
negative effects. Consumers also feel there is a higher chance of longer term effect of
recovery, and less of a chance of recurrence of illness as it is more healing –oriented,
where the focus is on activation of the natural reserves within the body, and rebuilding
of the resistance of illnesses.
43
Pain Relief and Control. Consumers have reported that utilizing TCM has given
them more energy, as a common complaint of cancer treatment is a feeling of being
drained, or feeling low on energy. A result of integrating TCM with their health care is
an increase in energy, and activity level.
One of the main reasons a majority of oncology patients choose to look into
TCM initially is its ability to provide relief from physical pain. Some choose to find
ways to manage their pain without the use of as many pain medications, and others
wish to be able to function again without being crippled by pain. By reducing a
patient’s reliance on prescription medication, it can give a sense of control back to the
individual.
Aside from relief from physical pain, consumers have also found that TCM may
relieve or decrease emotional pain and discomfort. There is reported relief from stress,
and a newfound freedom from the constraints of the illness. TCM can provide
sensations of calmness and relaxation. Consumers have also found that consistent use
of TCM may also decrease the frequency, intensity or duration of chronic complaints,
either as a result of treatment or chronic illnesses. Some have found that TCM use can
speed the healing after surgery, or can strengthen the immune system, reducing the
frequency of common illnesses, such as colds.
Improved Provider/Patient Experience. Another benefit is the improvement in
the experience that consumers have with their healthcare providers. Due to the
personal nature of TCM, this encourages personal conversations between patients and
doctors. Patients have stated that with the incorporation of TCM, they did not feel that
44
doctors were dictating their treatment, but that they had a more give and take
relationship, working with them on their treatment. This gives a feeling of more “hands
on care” from their providers. Since TCM believes that each individual is different,
each practitioner has different orders for individual patients. The practitioner and
patient establish a close, peer relationship and act together to treat the illness.
Several medical professionals have stated that they have patients who use
complementary medicine. They have seen the benefits to a patient’s overall
psychological wellbeing, and have found that when a patient’s family is in agreement
as well, it improves the relationship, not only between the patient and their providers,
but also within their personal relationships as well.
Family support becomes a very powerful part of a patient’s treatment. Many
times, the “cancer” diagnosis not only affects the individual, but also their loved ones
as well. By being able to pursue and understand treatment options together, families
and loved ones are able to play a bigger, more supportive role in a patient’s cancer
treatment.
Education. There is a common misconception that TCM is a “safe treatment”
which is a popular reason why many people choose this form of treatment. Though it is
true that there are fewer adverse side effects, it is still important that potential
consumers educate themselves about TCM, and choose a trained practitioner who is
aware of the other medical issues and medications that a patient may be using.
The TCM practitioner and the consumer need to be aware of the possible side
effects and counter-interactions of the TCM and the Western treatments. Before
45
practicing physical exercises like Qi Gong, although they are not harsh on the body,
one needs to be aware of one’s physical limitations. A good practitioner will be able to
work with a consumer to modify exercises to meet the patient’s physical ability.
Exercising Caution when Utilizing TCM. When choosing to use herbs in one’s
treatment, consumers should be aware that herbs in the U.S may be considered a drug if
it is used for treating or preventing diseases, as food if it is to be used for its taste,
nutrients or flavor, or as a dietary supplement when it is used to maintain health.
Consumers should also be aware that all dietary supplements require labeling that
includes supplement facts, directions of use, and name of the manufacturer, distributor
or importers. If a label does not contain these items, it may indicate counterfeit or
illegally imported products. All legal importers should have certificates of analysis or
vouchers that show their products comply with the manufacturer or importer
specifications. If one is buying from a non-reputable vendor, consumers run the risk of
the herbal products being substituted, misidentified, mislabeled, or contaminated.
There are risks when untrained professionals administer TCM. Complications
such as burns from cupping or punctured lungs from improperly placed acupuncture
needles are possible, and have happened. Before pursuing the TCM route, consumers
should do their own research, and educate themselves on the benefits, and possible
downside to incorporating TCM with their cancer treatment. When choosing
practitioners, find a reputable one who is trained and certified, same as one would do in
choosing a Western medical practitioner.
46
An opinion from a Qi Gong instructor states that patients should be aware that
Chinese medicine may take some time to work, before the individual may see some
benefits, or some change. If one does not notice change right away, do not get
discouraged, it does not mean that it is not working. She also states that Chinese
medicine, especially Qi Gong, has continued benefits, even after Western treatments
such as chemotherapy and radiation have stopped. She suggests continuing to practice
Qi Gong and other TCM if the provider and the patient find it beneficial.
An oncology nurse has also stated that she sees a benefit of TCM as “being
proactive in your health and taking charge.” However, she also warns, “The harm is
when patients do ONLY alternative methods and ignore traditional medicine. I do
think they can work together to complement each other if the patient is well informed
about the complementary medicine s/he is trying.”
Ultimately, hearing a diagnosis of cancer is a truly life-altering experience, both
for the patient and for the family. By taking an active part in one’s treatment, you can
take back the feeling of control that this diagnosis seems to take away. No matter what
route of treatment you decide to pursue, the key is to do as much research into the type
of cancer you have, and the treatment options and alternatives that are available to you.
In the end, only you will know what feels right for you.
Proposed Medical Social Work Position
Position Title: Clinical Social Worker MSW
Department: Social Service Department
Reports To: Manager, Social Service/Continuing Care
47
Position Summary:
Provides social work services to patients and families to facilitate their ability to
cope with psychological and social problems related to illness and hospitalization.
Provides appropriate discharge planning, abuse detection and reporting, referral,
consultation and counseling services.
This position requires providing care and/or service to critically or chronically
ill patients, ranging from newborns through geriatric patient populations in a manner
that demonstrates an understanding of the functional and/or developmental age of the
individual served. The focus of this position will be in the outpatient Cancer Center,
with a focus on assisting individuals dealing with the psychosocial issues surrounding
the diagnosis and treatment of cancer. This position will require education and focus
on the available Western medical treatments and the benefits when combining the
Western treatments with Traditional Chinese Medicine (TCM). The social worker will
be an advocate for patients choosing or considering utilizing TCM with Western
treatments.
With this position, regular training in oncology treatments will be required, both
Western treatments, as well as regular trainings in Traditional Chinese Medicine, both
herbal and exercises. The oncology social worker will be up to date on TCM options,
and be able to answer basic questions and suggest resources for patients possibly
considering alternative options.
This position requires the full understanding and active participation in fulfilling
the Mission of the Organization. It is expected that the employee will demonstrate
48
behavior consistent with the Core Values. The employee shall support the
Organization’s strategic plan and the goals and direction of the Performance
Improvement Plan (PIP).
Education/Training/Experience requirements
• Masters degree in Social Work from an accredited institution
• Experience in medical and psychiatric social work, crises intervention, and abuse
preferred
• Bilingual preferred
• Training in the benefits of Traditional Chinese Medicine for oncology patients
preferred
49
Chapter 5
SUMMARY AND RECOMMENDATIONS
This project consisted of a current literature review, website research, and a
questionnaire to medical professionals on Traditional Chinese Medicine, what this
consists of, such as acupuncture, cupping, herbal therapy, and Qi Gong. A brief
discussion about the history of TCM was included, and the basic belief of Qi, which is
the vital energy that flows through the human body. It is believed that illness is caused
by a disruption of the flow of Qi through the body. TCM seeks to correct the
misdirected or blocked flow of Qi to re-harmonize the body (Beal, 2000; Cassidy,
1998; Mainfort, 2004, Xu et al., 2006). The techniques of acupuncture, cupping, and
Qi Gong are used as ways to redirect an individual’s Qi.
This project was important in today’s Western society because the use of
alternative medicine is now so prevalent among consumers. There are several benefits,
especially for oncology patients, which include alleviating side effects of conventional
cancer treatments, to assisting with curing cancers, decreasing pain and discomfort, and
allowing patients to return to their prior level of functioning. Most importantly, it
allows patients to reclaim the feeling of control that is so commonly lost with cancer
diagnoses.
One of the main reasons why TCM is becoming so popular is its holistic
approach to treatment. Western medicine views the body as a mechanism in itself and
sickness is caused and affects only the body. TCM views illness and disease in the
50
context that the body is connected to the mind and spirit. Therefore, in order to treat a
person’s body, the mind and spirit need to be worked on as well. There is attraction
from patients because this point of view places the control of the treatment in the hands
of the consumer, with the practitioner playing an assisting role, where in Western
medicine, the physician is in control of the patient’s treatment (Cassidy, 1998;
Abdullah et. al, 2003).
There are some risks to utilizing TCM, especially when using herbs as there can
be adverse reactions to medications that patients may be taking. This is the reason why
it is so important for patients to inform their physicians of their use of herbal
supplements, and why physicians need to be aware of the herbs that are available.
There is a population out there that does not share with their physicians their TCM use
because they fear the doctor will disapprove or encourage the patient to stop using
alternative medicine (Eisenberg et. al, 1993; Simpson, 2003).
This project consists of a proposed medical social work position within an
oncology clinic. The purpose of this role is to encourage and advocate for patients’
right to choose and actively participate in their treatment plans. It is also important that
patients know where to go for TCM treatment should they choose to use this method.
There are risks if consumers do not use trained and certified practitioners of TCM. The
social worker will be able to guide and educate patients on where and how to find
reputable resources.
51
Along with this proposed position, a guide to TCM is also included. Within this
guide, basic information on TCM is provided. The guide is created to describe some of
the benefits and risks of TCM in an easy to understand format.
Based on the findings of the research done, there are several benefits for
oncology patients to utilize TCM in conjunction with Western cancer treatments. Both
disciplines have benefits, and, if used correctly, together TCM and conventional
treatments will maximize the benefits for patients. Due to the popularity of alternative
medicines, and the risks that are involved, both patients and medical staff need
information and education. Physicians and medical staff will need to learn to be more
accepting of patients’ choices to pursue and include alternative medical treatments.
Evaluation
There is an abundance of information out there on TCM, and all its different
aspects. It would have been beneficial to focus on one aspect, such as Qi Gong, and
delve deeper into its benefits. For future research, perhaps data from oncology patients
may have been helpful in order to gain their perspective on the benefits and harm of
combining TCM and traditional cancer treatment. Another approach would be to create
a manual for medical staff regarding Traditional Chinese Medicine, and how to work
with patients who choose to incorporate complementary medicines. The acceptance of
TCM in the Western medical field is still new, and will need support in order to help it
grow.
52
Implications for Social Work
The information within this project will affect medical social workers
because of the large number of patients who are currently or will utilize TCM in the
future. A majority of these patients feel they have to hide their use of alternative
medicines from their practitioners, which may be harmful to patients. By being aware
of this information, social workers are able to advocate for their clients choices and
active participation in their medical treatments. When the medical social worker is
educated about TCM, and on the available resources available to patients, they can
guide patients in the right direction for pursuing safe choices. By being aware of what
is available out there, the social worker can have resources and information for patients
about the different choices of treatment, and will assist patients in being able to
communicate these choices to the medical staff.
53
APPENDICES
54
APPENDIX A
Questionnaire
The following is a questionnaire for a Master’s project on a resource guide to
Traditional Chinese Medicine for oncology patients. As a medical professional, your
experiences and input would greatly assist in the production of this resource guide.
Your time and input is greatly appreciated. Thank you in advance for completing this
survey.
Profession:__________________________
Date:_____________
1.
In your experience, how do gender and age play a factor in how a patient handles
their cancer diagnosis?
2.
How does a patient’s cultural, or spiritual beliefs play a role in their oncology
care?
55
3.
How does family support play a role in a patient’s oncology care?
4.
How does empowering a patient affect their care?
5.
Have you utilized/ observed a patient utilize Chinese medicine in their oncology
care?
56
6.
What benefits/harm, have you observed from the use of alternative or
complementary medicine with oncology patients?
7.
How do you encourage a patient’s active participation in their oncology care?
57
APPENDIX B
Consent Form: Bridging the Gap between Eastern and Western Medicine: A resource
Guide to Chinese Medicine for oncology patients
My name is Bena Chan, a Master of Social Work student who is completing her
master’s project for the social work program. I am conducting research on Traditional
Chinese Medicine for cancer patients. I am investigating this in order to create a
resource guide for oncology patients about Traditional Chinese Medicine. You will be
asked to complete a survey consisting of 7 questions.
The survey and all data collected will be confidential, only your profession will
be requested on the questionnaire and included in reporting the results. No other
identifying information will be requested or reported.
If you take part in this project, your information and experiences will contribute
to the creation of a resource guide for cancer patients. Taking part in this project is
voluntary; there will be no financial incentives for participation or any consequences to
participation. You may choose to withdraw from participation at any time.
If you have any questions about the research, please contact me by email at:
benachan20@yahoo.com. This project is being advised by faculty Robin Kennedy,
email: kennedyr@csus.edu.
Sincerely,
Bena Chan, Social Work Graduate Student
________________________________
Signature
_____________
Date
58
REFERENCES
Abdullah, A.S.M., Lau, Y., & Chow, L.W.C. (2003). Pattern of alternative medicine
usage among the Chinese breast cancer patients: Implication for service
integration. The American Journal of Chinese Medicine. 31(4). 649-658.
Bandura, A. (1982). Self-efficacy mechanism in human agency. American
Psychologist, 37, 122-147.
Barrett, B., Marchand, L., Scheder,J., Appelbaum, D., Chapman, M., Jacobs, C.,
Westergaard, R., & St. Clair, N. (2000). Bridging the gap between conventional
and alternative medicine. The Journal of Family Practice. 49(3). 234-239.
Bartlett, H. M. (1975). Ida M. Cannon: Pioneer in medical social work. Social Service
Review, 49(2), 1-20.
Beal, M.W., (2000). Acupuncture and oriental body work: Traditional and biomedical
concepts in holistic care: History and basic concepts. Holistic Nursing Practice.
14(3). 69-78.
BFI, (March 21, 2007). Medical model vs. social model. Retrieved April 12, 2007
from
http://www.bfi.org.uk/education/teaching/disability/thinking/medical.html
Burke, A., Wong, Y.Y., & Clayson, Z. (2003). Traditional medicine in china today:
Implications for indigenous health systems in a modern world. American Journal
of Public Health. 93 (7). 1082-1084.
Cassidy, C.M., (1998). Chinese medicine users in the united states Part II: Preferred
aspects of care. The Journal of Alternative and Complementary Medicine. 4(2).
189-202.
Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F.E., Calkins, D. R., & Delbanco,
T. L., (1993). Unconventional medicine in the United States: Prevalence, costs,
and patterns of use. New England Journal of Medicine, 328, 246-252.
Fox, N.J., Ward, K.J., & O’Rourke, A.J., (2005). The ‘expert patient’: empowerment
or medical dominance? The case of weight loss, pharmaceutical drugs and the
internet. Social Science & Medicine. 60. 1299-1309.
Galambos, C. M., (2005). Celebrating 30 years of scholarship in health and mental
health. Health & Social Work. 30 (4). 275-277.
59
Garvin, C. (1985). Work with disadvantaged and oppressed groups. In M. Sundel, P.
Glasser, R. Sarri, & R. Vinter (Eds.), Individual Change Through Small Groups
(2nd ed.) (pp.461-472). New York: The Free Press.
Ghayur, M. N., (2009). Traditional chinese medicine research and education in Canada.
The Journal of Alternative and Complementary Medicine. 15(6). 689-694.
Haslam, M. (February, 2001). Stigma and the medical model. Gendy’s Journal, 13.
Retrieved April 10, 2007 from
http://www.gender.org.uk/gendys/2001/13hslam.htm
Hirayama, H., & Hirayama, K. (1985). Empowerment through group participation:
Process and goal. In M. Parenes (Ed.), Innovations in Social Group Work:
Feedback From Practice to Theory (pp. 119-131). New York: Haworth.
Janoff-Bulman, R. (1979). Characterological versus behavioral self-blame: Inquiries
into depression and rape. Journal of Personality and Social Psychology, 37,
1798-1810.
Johnson, T., (1999). Mds skeptical as BC gives stamp of approval to traditional
Chinese medicine. Canadian Medical Association Journal. 161 (11). 1435-1436.
Keefe, T. (1980). Empathy skill and critical consciousness. Social Casework, 61, 387393.
Kieu, A. (July, 2002). Alternative medicine in breast cancer. UCLA Department of
Medicine. Retrieved November 29, 2006 from
http://www.med.ucla.edu/modules/wfsection/article.php?articleid=202
Ko, R. (2006). Safety of ethnic & imported herbal and dietary supplements. Clinical
Toxicology. 44. 611-616.
Kreuger, L. and Neuman, L. (2006). Social Work Research Methods: Qualitative and
Quantitative Applications (2nd Ed). Boston: Allyn and Bacon
Lee, T.S., Chen, H.H., & Yeh, M.L., (2006). Effects of chan-chuang qigong on
improving symptom and psychological distress in chemotherapy patients. The
American Journal of Chinese Medicine. 34(1). 37-46.
Longres, J., & McLeod, E. (1980). Consciousness raising and social work practice.
Social Casework, 61, 267-227.
Mainfort, D. (2004). The physician-shaman early origins of traditional Chinese
medicine. Skeptic. 11 (1). 36-39.
60
Mason, M., (2008). Pain relief to a point. Nursing Standard. 22(51). 22-23.
Mizrahi, T., & Berger, C.S., (2001). Effect of a changing health care environment on
social work leaders: Obstacles and opportunities in hospital social work. Social
Work. 46 (2). 170-182.
Molassiotis, A., Sylt, P., & Diggins, H. (2007). The management of cancerrelated fatigue after chemotherapy with acupuncture and acupressure: A
randomized controlled trial. Complementary Therapies in Medicine. 15: 228-237.
Normile, D. (2003). The new face of traditional Chinese medicine. Science. 299
(5604). 188-190.
Pernell, R. (1985). Empowerment and social group work. In M. Parenes (Ed.),
Innovations in social group work: Feedback From Practice to Theory (pp. 107117), New York: Haworth.
Pinderhughes, E. (1983). Empowerment for our clients and for ourselves. Social
Casework, 64, 331-338.
Powers, P. (2003). Empowerment as treatment and the role of health professionals.
Advances in Nursing Science. 26 (3). 227-237.
Riolo, J.A. (2004). The medical model: What is it? Retrieved April 10, 2007 from
http://www.psychjourney.com/The%20Medical%20Model%20%20What%20Is%
20It.htm
Robertshawe, P., (2008). Cancer-related fatigue managed with acupuncture and
acupressure. Journal of the Australian Traditional-Medicine Society. 14(4). p.
229.
Ross, J.W. (1995). Hospital social work. In R.L. Edwards (Ed.-in-Chief).
Encyclopedia of Social Work (19th ed., Vol. 2, pp.1365-1377). Washington, DC:
NASW Press.
Rossman, M.L., (2003). Fighting for health. Advances. 19(2). 6-7.
Sherman, W., & Wenocur, S. (1983). Empowering public welfare workers through
mutual support. Social Work, 28, 375-379.
Shia, G., Shaw, D., & Dargan, P. I. (2004). Assessing health risks of complementary
alternative medicines in cancer patients. British Journal of Cancer.91 (5). 995997.
61
Shinnick, P. (2006). Qigong: where did it come from? Where does it fit in science?
What are the advances? The Journal of Alternative and Complementary
Medicine. 12 (4). 351-353.
Simmons, C., & Parsons, R. (1983a). Developing internality and perceived
competence:The empowerment of adolescent girls. Adolescence, 18, 917-922.
Simmons, C., & Parsons, R. (1983b). Empowerment for role alternatives in
adolescence. Adolescence, 18, 193-200.
Simpson, P.B., (2003). Family beliefs about diet and traditional Chinese medicine for
hong kong women with breast cancer. Oncology Nursing Forum. 30(5). 834840.
Solomon, B. (1976). Black empowerment. New York: Colombia University Press.
The health benefits of tai chi (2009). Harvard Women’s Health Watch, 16 (9). 2-4.
Toofany, S. (2006). Patient empowerment: Swaleh toofany examines the concept of
empowerment in public health. Nursing Management, 13 (6). 18-22.
Verhoef, M.J., Mulkins, A., & Boon, H. (2005). Integrative health care: How can we
determine whether patients benefit? The Journal of Alternative and
Complementary Medicine. 11(1). S-57-S-65.
Wong, W.C.W., Lee, A., Wong, S.Y.S., Wu, S.C., & Robinson, N. (2006). Strengths,
weaknesses, and development of traditional Chinese medicine in the health
system of hong kong: Through the eyes of future western doctors. The Journal of
Alternative and Complementary Medicine. 12 (2). 186-189.
Xu, W., Towers, A.D., Li, P., & Collet, J.P. (2006). Traditional Chinese medicine in
cancer care: Perspectives and experiences of patients and professionals in china.
European Journal of Cancer Care. 15, 397-403.