# The Use Of Complementary Medicines Among Cancer Patients In France The Increasing Role Of Asian Medicines

Pierre Ricono, Olivier Las Vergnas, Jean Heutte

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Pierre Ricono, Olivier Las Vergnas, Jean Heutte. The Use Of Complementary Medicines Among Cancer Patients In France The Increasing Role Of Asian Medicines. Joint Conference of IASTAM (International Association for the Study of Traditional Asian Medicine) and ASHM (Asian Society for the History of Medicine), IASTAM and ASHM, Jun 2024, TAIPEI, France. hal-04651277

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# The Use Of Complementary Medicines Among Cancer Patients In France
## The Increasing Role Of Asian Medicines

Pierre RICONO-Olivier LAS VERGNAS-Jean HEUTTE-Université de Lille (CIREL research unit)

XX Joint Conference of IASTAM and ASHM
# Contents

1. The environment of cancer patients

2. The CAM (Complementary Alternative Medicine)

3. Reasons given by patients for using CAM

4. Who can practice CAM, acupuncture in France ?

5. Process regarding acupuncture support

6. Traditional Chinese Medicine (TCM) in France

7. Hospital with CAM proposals

8. The MAC'EVAL study and others...

9. Conclusion

10. Bibliography
# The environment of cancer patients

<figure><img src="image_2.png" /></figure>

Conceptual framework of the decision-making process for Complementary and Alternative Medicine by patients with cancer. Laura Weeks, Lynda G Balneaves, Charlotte Paterson, Marja Verhoef (2014)
# The Complementary Alternative Medicine (CAM)

<figure><img src="image_3.png" /></figure>

unconventional healthcare practices have been identified by the WHO divided into 5 categories :

400

**Whole medical systems**

**Biologically based practices**

**Energy therapies**

**Manipulative and body-based therapies**

**Mind-body techniques**

80%

of the world's population uses a CAM

71%

of French people have already used an unconventional healthcare practice

60%

of French people who use an unconventional healthcare practice have cancer
# Reasons given by patients for using CAM

The three reasons given by patients for CAM use were:

* having an expectation of benefits of CAM

* dissatisfaction with conventional medicine

* the perceived safety of CAM

The aim is foremost to feel better with side effects, to relieve symptoms and strengthen the body's ability to manage the disease:

* by reducing nausea, fatigue, pain... due to chemotherapy.

* helping limit burns from radiotherapy

* in the case of hormone therapy used for gynecological cancers, limiting night sweats effective

* hand-foot syndrome by eliminating violent tingling sensations and intense burning of the extremities

* enabling patients to continue their treatment at the maximum dose for as long as possible, and thus not compromise their chances of recovery.

Acupuncture is most well-known analgesic effect, enhance endogenous endorphins. The Nicolas Commission in 2002 led to the recognition of acupuncture and homeopathy as legal medical practices.
# Who can practice CAM, acupuncture in France ?

The French Medical Council officially recognizes 4 types of CAM, known as "unconventional healthcare practices": **acupuncture, homeopathy, mesotherapy and osteopathy**.

Acupuncture is only reimbursed by the national health insurance scheme for 4 indications :

* nausea and vomiting,

* pain relief,

* anxiety-depression syndrome

* alcohol and smoking cessation.

There are over 3 000 acupuncturists in France, with around 800 practicing acupuncture exclusively.
As far as the medical professions are concerned, there are an estimated 1 632 doctors who practise acupuncture in France, i.e. around 3% of general practitioners in the private sector, and 21% of doctors with special practices (homeopaths, naturopaths, etc).

There are also between 4 000 and 6 000 people in France who "practise acupuncture illegally", without a recognised health diploma.

Some practitioners in France consider that acupuncture is not medicine in the Western sense of the term, but a Chinese practice, and that the illegal practice of medicine does not therefore concern them.
# TCM in France : who can practice what?

<table><thead><tr><th></th><th>Acupuncturists</th><th>Midwives<br>acupuncturists in their<br>field of expertise</th><th>Health professionals<br>(physiotherapists,<br>nurses) who practise<br>Chinese medicine</th><th>Other practitioners of<br>Chinese medicine</th></tr></thead><tbody><tr><td>Medical acupuncture<br>(regulated practice<br>reimbursed by social<br>security, requiring a state<br>qualification)</td><td>yes</td><td>yes</td><td>no</td><td>no</td></tr><tr><td>Traditional acupuncture<br>or moxibustion</td><td>yes</td><td>yes</td><td>yes</td><td>yes</td></tr><tr><td>TCM (acupuncture or<br>Chinese moxibustion,<br>Chinese dietetics,<br>Chinese massage, qi<br>gong, etc.)</td><td>yes</td><td>yes</td><td>yes</td><td>yes</td></tr></tbody></table>

Only doctors, dentists and midwives holding a DU in Chinese medicine are entitled to practise it. Considered a medical procedure, acupuncture is used in oncology to alleviate some of the effects of chemotherapy, including vomiting and the joint pain induced by certain hormone therapies.
# Process regarding acupuncture support

<figure><img src="image_4.png" /></figure>

For chemotherapy one session 48 hours before the session (to boost platelets) and one session on the same day or the following day to neutralize the treatment's side effects.

<figure><img src="image_5.png" /></figure>

For radiotherapy, one session a week can be scheduled during radiation to reduce redness and burning.

<figure><img src="image_6.png" /></figure>

During surgery, the optimal timing is to schedule one session 48 hours before surgery to reduce the stress associated with the procedure, and one session on discharge from hospital or clinic to reduce fatigue and aid healing.

<figure><img src="image_7.png" /></figure>

To support the immune system. Regular follow-up over a 4-month period helps to keep people's vital energy flowing.

Professor Philippe Jeannin indicates cancer by cancer the points to be pricked by needles
https://www.medecin-acupuncteur-paris.com/acupuncture-suites-de-soins-chimiotherapie-en-cancerologie
# 4 types of patient using acupuncture Patrick Triadou (2005)

<figure><img src="image_8.png" /></figure>
# Hospitals with CAM proposals

<figure><img src="image_9.png" /></figure>

2006 one University Hospital Center (CHU) Paris

2016 two University Hospital Center (CHU) Lyon/Nantes

2017 two University Hospital Center (CHU) Metz/Ales

2018 one Raphaël Institut Integrative Ealth (IR) Levallois

2019 one University Hospital Center (CHU) Paris

2020 one University Hospital Center (CHU) Paris

2023 one Integrative Medecine Center (CMI) Rebreuviette

2024 a total of 9 places propose CAM oncology with (Naturopathy, Acupuncture, Reflexology, Shiatsu, Auriculotherapy, Yoga, Qi gong, Fasting....)

According to AFSOS (French Association of Oncological Supportive Care) :
In 2018 15-20% of cancer patients use acupuncture
# The MAC'EVAL study

<figure><img src="image_10.png" /></figure>

CAM'Eval study (2018-2023)

Saint Joseph Hospital. Paris

https://ichgcp.net/fr/clinical-trials-registry/NCT03954509

Thesis in progress:

- thesis supervisor Las Vergnas O.

- co thesis supervisor Heutte J.

Qualitative empirical method :

* Grounded informed methodology (Thorberg)

Mixed analysis :

* Iramuteq semantic analysis of verbatims from the corpus of interviews

Categories identification, codage with Likert scale

* Principal Component Analysis (PCA) with R

## Characteristics of the cohort

<table><thead><tr><th></th><th>number (%)</th><th></th><th></th></tr></thead><tbody><tr><td>Gender</td><td></td><td>Age</td><td></td></tr><tr><td>Masculin</td><td>24 (48.0)</td><td>Mean</td><td>66.4</td></tr><tr><td>Féminin</td><td>26 (52.0)</td><td>Maximum-Minimum</td><td>35-86</td></tr><tr><td>Age, years</td><td></td><td>standard deviation</td><td>11</td></tr><tr><td>&gt;60</td><td>36 (72.0)</td><td>18-55 ans =</td><td>10(20.0)</td></tr><tr><td>≤60</td><td>14(28.0)</td><td>56-65 ans =</td><td>7(14.0)</td></tr><tr><td>Professional status</td><td></td><td>66-75 ans =</td><td>23(46.0)</td></tr><tr><td>retired</td><td>32 (64.0)</td><td>&gt;75 ans =</td><td>10(20.0)</td></tr><tr><td>working</td><td>18 (26.0)</td><td>Time elapsed between diagnosis and interview</td><td></td></tr><tr><td>Occupation (executive, non-executive)</td><td></td><td>Mean</td><td>11.38</td></tr><tr><td>Technician, superviso</td><td>27 (54.0)</td><td>Maximum-Minimum</td><td>1-48</td></tr><tr><td>Clerk, worker</td><td>23 (46.0)</td><td>Time elapsed between diagnosis and interview</td><td></td></tr><tr><td>Studies</td><td></td><td>≤6</td><td>30(60)</td></tr><tr><td>higher education</td><td>26 (52.0)</td><td>&gt;6&lt;12</td><td>14(28)</td></tr><tr><td>lower education</td><td>24 (48.0)</td><td>&gt;12</td><td>6(12)</td></tr><tr><td>Type de Cancer</td><td></td><td>Length of interviews</td><td>minutes</td></tr><tr><td>Lungs</td><td>28 (56.0)</td><td>Mean</td><td>36</td></tr><tr><td>Breasts</td><td>6 (12.0)</td><td>Maximum-Minimum</td><td>20-90</td></tr><tr><td>Digestif</td><td>12 (24.0)</td><td></td><td></td></tr><tr><td>Others</td><td>4(08.0)</td><td></td><td></td></tr><tr><td>Cancer stage</td><td></td><td></td><td></td></tr><tr><td>I-III</td><td>421 (92.0)</td><td></td><td></td></tr><tr><td>IV</td><td>36 (7.9%)</td><td></td><td></td></tr><tr><td>Use of CAM after diagnosis</td><td></td><td></td><td></td></tr><tr><td>yes</td><td>14 (28.0)</td><td></td><td></td></tr><tr><td>no</td><td>49 (8.5)</td><td></td><td></td></tr></tbody></table>
# MAC'EVAL some results (50 interviews)

<figure><img src="image_11.png" /></figure>
MAC'EVAL some results

<figure><img src="image_12.png" /></figure>
# CAM users studies among cancer patients in France

<figure><img src="image_13.png" /><figcaption>Acupuncture</figcaption></figure>

<figure><img src="image_14.png" /></figure>

<figure><img src="image_15.png" /></figure>

Simon et col.2007

Träger et col.2007

Morandini 2011

Saghatchian et col. 2014

Legrand 2018

Serrier 2022

Ricono et col.2023
# MAC'EVAL Patient attitudes about treatment

<figure><img src="image_16.png" /></figure>

<figure><img src="image_17.png" /></figure>

**Prefering-Allegiance**
CAM exclusion

**Fatalistic**
CAM separation

<figure><img src="image_18.png" /></figure>

**Reflexive**
CAM inclusion

<figure><img src="image_19.png" /></figure>

**Combative**
CAM integration
Conclusion

* The use of CAM mobilizes beliefs, emotions and agentivity linked to the different stages of the disease. The transparency nature of exchanges in the management of side-effects, can lead to the co-construction of supportive care and towards an integrative medicine that humanizes care and recognizes patients' experiences and choices.

* Using CAM and medical pluralism stimulates patients' reflexivity, from seeking information about their disease, to questioning the medical team, to choosing supportive care, sharing experiences with groups of patients, enabling them to do their part and question the meaning they want to give to their agentivity and their resistance to evil.

* There is a common denominator to all these CAM, which is the approach to the individual as a whole and as a subject-actor in his or her own life, are seen elsewhere.

* TCM is one of comprehensive global health system that includes acupuncture, mind-body techniques such as qi gong and tai-chi-chuan, nutrition, herbal medicine and energetic massage. It is a highly personalised therapeutic approach (the practitioner adapts his treatment according to the patient in front of him).

* More and more patients, often because they have developed a distrust of drugs, are turning to CAM and seem satisfied.
# Bibliography

Hopital Saint Joseph : Évaluation des besoins des patients atteints de cancer avec des médecines complémentaires et alternatives (MAC'EVAL)
https://ichgcp.net/fr/clinical-trials-registry/NCT03954509 (2023)

Kane H., Gourret BaumgartJ., Denis F. Les soins oncologiques de support : une ressource inégalement mobilisée face au cancer (2023)
https://www.cairn.info/revue-sciences-sociales-et-sante-2023-4-page-5.htm

Acupuncture et cancer
https://www.afsos.org/wp-content/uploads/2014/12/Acupuncture-et-cancer_AFSOS.pdf

Serrier J. Le recours à l'acupuncture en soins de support : motivations et attentes des patients atteints de cancer (2017)
https://bibnum.univ-lyon1.fr/nuxeo/nxfile/default/9d793191-a6be-47c9-8cff-1c6282fe198e/blobholder:0/THm_2017_SERRIER_Julie.pdf

Médecines complémentaires à l'Assistance Publique Hôpitaux de Paris (2016)
http://docplayer.fr/3847095-Médecines-complementaires-a-l-assistance-publique-hopitaux-de-paris-rapport.html

Jeannin P. Traitement par Acupuncture du syndrome mains-pieds chez les patients sous chimiothérapie (2008)
https://meridiens.org/acuMoxi/neufdeux/jeannin.pdf

Jeannin P. Place de l'acupuncture dans le cancer du sein (2008)
https://meridiens.org/acuMoxi/septquatre/JEANNIN.pdf
https://www.medecin-acupuncteur-paris.com/acupuncture-suites-de-soins-chimiotherapie-en-cancerologie

Triadou P. Les Patients souffrant de cancers et la médecine traditionnelle chinoise. Expérience des patients de la MTC et définition de la complémentarité
https://meridiens.org/acuMoxi/neuftrois/triadou9-3.pdf (2010)

Triadou P. L'acupuncture en France aujourd'hui. Typologies des patients (2006)
https://meridiens.org/acuMoxi/triadou.pdf