Understanding complementary therapies

The term complementary therapies covers a broad range of practices and medicines. They can be grouped into different categories and most are part of whole medical systems.

Whole medical systems aim to treat the whole person – mind, body and spirit – not just the disease and its symptoms. In Australia, the main whole medical systems used are Ayurvedic medicine, Chinese medicine, homeopathy and naturopathy.

This is the combined use of conventional treatments and evidence-based complementary therapies. This approach has been adopted by some cancer centres.

Using complementary therapies in palliative care

Many palliative care services offer complementary therapies to patients to help improve their quality of life.

Therapies such as aromatherapy, massage, meditation and reflexology can increase a person’s sense of control, decrease stress and anxiety, and improve mood.

Health professionals involved in palliative care often support patients using complementary therapies that are safe and evidence-based.

Complementary therapies are widely used by people with cancer in Australia. There are many reasons why people with cancer use complementary therapies, including to:

• improve quality of life
• take a more active role in their health and recovery
• manage the symptoms and side effects of conventional cancer treatment, such as fatigue, nausea or pain
• strengthen the mind and body to cope with treatment
• look for more holistic ways of treating the whole person
• incorporate traditional or cultural practices.

Yes. Discuss any therapy you are using or thinking about using with your doctors, as some may not be safe or evidence-based. This includes over-the-counter medicines, herbal supplements and vitamins that you buy from a pharmacy or health food store.

It’s important to tell your doctors before you start using any complementary therapy, especially if you are having chemotherapy or radiation therapy or taking any medicines. Depending on the treatment you are having, some complementary therapies may cause reactions, make side effects worse or interfere with the success of your conventional cancer treatment.

Your doctors may advise you to avoid some complementary therapies while you are having cancer treatment. Your doctor may also be able to refer you to a qualified therapist who understands the role of complementary therapies in cancer care. 

Complementary therapies can be grouped into the following 4 categories. Some therapies fit into more than one category.

Mind–body practices

Mind–body practices are based on the belief that what we think and feel can affect our physical and mental wellbeing.

Mind–body practices may also be called psychological techniques, emotional therapies or spiritual healing.

When our emotions or mental state are under pressure, our physical body can be affected. Similarly, physical symptoms can have a negative impact on our mood and mental wellbeing.

Examples – art therapy, counselling, hypnotherapy, laughter yoga, meditation, mindfulness, music therapy, relaxation, spiritual practices.

Body-based practices

Body-based practices work directly on your body. They may also be described as bodywork or touch therapies.

Some techniques are passive – therapists apply some form of touch or manual pressure to your body. Other practices require you to do a series of movements to stimulate and stretch different parts of the body.

Therapies such as acupuncture, tai chi, qi gong and yoga have a strong mind–body connection, so they may benefit both physical and emotional health.

Examples – acupuncture, aromatherapy, massage, qi gong, reflexology, tai chi, yoga.

Energy therapies

Energy therapy is based on the belief that the body has an invisible energy field, and when this energy flow is blocked or unbalanced, you can become sick. Unblocking this energy is said to help promote healing and wellbeing.

This vital energy or life force is known by different names in different whole medical systems – for example, qi in Chinese medicine and prana in  Ayurvedic medicine.

There is no scientific evidence of an energy field or that energy therapies have any benefits.

Examples – healing touch, reiki.

Therapies using herbs and plants

Herbal remedies, also known as botanical medicine, have been used in many traditional medicine systems. They are produced from all parts of a plant including the roots, leaves, berries and flowers. These may contain active ingredients that may cause chemical changes in the body.

Herbal remedies are often taken by mouth or applied to the skin to treat disease and promote health.

There is no reliable scientific evidence that herbal remedies alone can cure or treat cancer.

Examples – bush remedies, Chinese herbal medicine, flower remedies, medicinal cannabis, Western herbal medicine.

A clinical trial can help show whether a treatment works and is safe. In a randomised control trial, one group of people is given the new treatment and the other group is given the existing standard treatment. The results in the two groups are compared to work out which treatment is better, safer and/or more cost-effective.

If a trial proves that a treatment is better than existing options, it may become the new standard of care for patients in the future. Some clinical trials compare existing approaches to see which one is more effective.

Clinical trials for complementary therapies often test treatments on small groups of people with specific cancer types, such as breast and prostate. It can be challenging to establish whether the trial results apply to people with other types of cancer.

Personal (anecdotal) evidence is based on individual people’s experiences and observations, rather than on facts. It is not proven and is less reliable than scientific evidence from clinical trials.

Download our booklet ‘Understanding Clinical Trials and Research’

Cancer Council supports the use of complementary therapies that have been proven to be generally safe and effective in clinical trials or other scientific studies. Therapies such as meditation, massage and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood.

Some evidence supporting the use of individual therapies is summarised on the ‘Individual therapies’ page. Only some of the therapies mentioned have been scientifically proven to be safe or effective to use for people with cancer. Where the evidence is not available, the possible benefits and any harm they might cause should be considered by you and your health care team.

Many health claims for complementary therapies have not been proven. However, anecdotal evidence from people with cancer – and, in some cases, a long history of use in traditional medicine – suggest that particular therapies may be useful for some people.

Allied health professionals, such as physiotherapists, exercise physiologists, dietitians and psychologists, offer a range of evidence-based therapies to diagnose and treat health conditions.

These therapies can offer people with cancer physical, emotional, spiritual and practical support, help reduce side effects from medical treatment,  and improve quality of life.

Many allied health practices are part of standard supportive care for cancer and allied health professionals are often members of multidisciplinary cancer teams. They have a university qualification in a recognised allied health field. They are also a member of a national professional organisation that:

• certifies qualifications
• sets and maintains competency standards
• oversees continuing professional development
• has a procedure for dealing with complaints about its members.

Your general practitioner (GP) or specialist can refer you to a range of allied health professionals who have experience working with people affected by cancer. Some allied health therapies can be claimed under Medicare if you have a referral from your GP as part of a Chronic Disease Management  Plan.

Keep the following warning signs in mind about any therapy or medicine you are thinking about using alongside or instead of a conventional  treatment or medicine.

• Any claims that the treatment cures cancer and other illnesses.
• The treatment costs a lot of money, you need to pay in advance for several months’ supply or you can only buy it from the therapist.
• The medicine is not listed with the Therapeutic Goods Administration (TGA).
• The therapist is not qualified in the therapy they provide or not registered with a governing body or professional association.
• The therapist tells you not to use conventional treatment or medicine as it will stop their therapy or remedy from working.
• The therapist suggests changes to your conventional treatment, asks you not to talk to your doctors about the treatment, or won’t tell you what the ingredients are in a herbal preparation they give you.
• The therapist says there are clinical studies showing the effectiveness of their remedy or therapy, but does not show you any articles that have appeared in trustworthy journals reviewed by other scientists.
• The therapist says that the medicine has worked miraculously in other people.
• All potential side effects have not been explained.
• You need to travel overseas to have the treatment.

The Australian Competition and Consumer Commission (ACCC) tracks health and medical scams to help the public spot and avoid scams. To find out more, visit their websites at Scamwatch or the Australian Competition and Consumer Commission (ACCC).

Studies show that most people with cancer who use complementary therapies don’t tell their doctors. This is because they worry their doctors will disapprove.

The use of complementary therapies is growing, so many doctors are now better informed about them and are often supportive of their use. Some doctors and nurses have been trained in complementary therapies and are able to give you information about them. Complementary therapies are also available at some cancer treatment centres.

To keep yourself safe, have the following conversations:

Talk to your doctors – It is important to discuss your interest in complementary therapies with your GP, cancer doctors and nurses. Let them know about any specific therapies you are using or thinking about trying.

Talking with your cancer care team allows them to:

• consider your safety and wellbeing
• discuss possible side effects or interactions with conventional treatments and medicines
• suggest other complementary therapies that may help with the issues you have
• refer you to a qualified therapist experienced in working with people with cancer.

Your surgeon, medical oncologist or radiation oncologist may raise specific concerns, such as not using particular creams or medicines at certain times during your treatment. If you are taking herbs or nutritional supplements, they may suggest you stop taking these before, during or after particular treatments.

Talk to your complementary therapist – It is also important to tell your complementary therapist that you have cancer, and inform them of the conventional treatments and medicines you’re having.

Some therapies may need to be adjusted or avoided to prevent interactions with your conventional cancer treatment.

Ask your therapist what information they need from your cancer specialists to help you avoid risky treatment and drug interactions.

All herbs should be prescribed by a qualified therapist. Although herbs are natural, they are not always safe. Taking the wrong dose or combination, or using the wrong part of the plant, may cause side effects or be poisonous (toxic). Serious side effects include damage to the liver or kidneys.

Some Ayurvedic and Chinese products have been shown to contain lead, mercury and arsenic in high enough quantities to be considered toxic. Other herbal preparations have been found to contain pesticides and prescription medicines.

There are things you can do to use herbal products safely:

• Buy herbal products from a qualified therapist or reputable supplier.
• If your therapist is making up a preparation for you, ask for it to be clearly labelled in English with your name, date, quantity, ingredients, dosage, directions, safety information (if applicable) and your therapist’s contact details.
• Avoid buying over-the-counter products online. Products from other countries that are available over the internet are not covered by the same quality and safety regulations as those sold in Australia, and may not include the ingredients listed on the label.
• Make sure you know how to prepare and take your herbs. Like conventional medicine, taking the correct dose at the right time is important for the safe use of herbal remedies.
• Check the label for any warnings about side effects and drug interactions. Talk to your doctor and complementary therapist about possible side effects and what you should do if you experience them.
• Report any suspected adverse reactions to any kind of medicine to your therapist or doctor. If the reaction is serious, call Triple Zero (000) or go to your nearest emergency department.

Using herbs and supplements during treatment

Some common herbs and supplements have been shown to cause harmful interactions with cancer treatments, including surgery, radiation therapy and chemotherapy. Talk to your surgeon or oncologist about whether you need to stop taking any herbs or supplements before treatment.

St John’s wort – This popular herb for mild to moderate depression has been shown to stop some chemotherapy drugs and other medicines working properly. It may also increase skin reactions to radiation therapy. If you are feeling depressed, ask your doctor about other treatments.

Black cohosh – Herbalists often prescribe this herb to menopausal women who are having hot flushes, however, it has not been shown to help. While clinical trials show that black cohosh is relatively safe, it should not be used by people with liver damage. There is no evidence to support the use of black cohosh in people with cancer.

Fish oil, ginkgo biloba and garlic – Studies have shown that these products may have a blood-thinning effect, which can cause bleeding. This could be harmful in people with low platelet levels (e.g. from chemotherapy) or who are having surgery.

Green tea – This has been shown to stop the cancer drug bortezomib from working properly.

Keep your complementary therapists and other health professionals informed about any herbs and supplements you use before, during or after  cancer treatment. This will help them give you the best possible care.

For more information on the effects of specific herbs and botanicals, visit the Memorial Sloan Kettering Cancer Center website. You can also download their About Herbs app to your smartphone or tablet.

Concentrated oils extracted from plants, such as lavender or tea tree, are called essential oils. Before being applied to the skin, essential oils need to be diluted by being mixed with a base oil. Base (or carrier) oils are usually made from kernels or nuts, such as almonds. Sometimes mineral oil is used instead as it is odourless.

Allergic reactions to oils are rare, but some people find they irritate the skin, or the smell makes them feel nauseous or gives them a headache. Let your therapist know if you have had reactions to oils in the past, or if you find certain smells unpleasant.

The Therapeutic Goods Administration (TGA) is an Australian Government department that assesses and monitors (regulates) all therapeutic goods and medicines sold in Australia. This includes complementary medicines such as herbs, vitamins, minerals, nutritional supplements, homeopathic remedies and some aromatherapy products.

The regulation of complementary medicines helps to protect the public. It helps ensure that therapeutic goods are produced to an acceptable standard of safety and quality (good manufacturing practice) and that any adverse reactions can be investigated.

Most therapeutic goods supplied in Australia – whether made in Australia or overseas – must be included on the Australian Register of Therapeutic Goods (ARTG). Some homeopathic preparations are exempt from this requirement. Visit the Australian Register of Therapeutic Goods (ARTG) to search the ARTG for a specific medicine.

To be included on the ARTG, medicines will be given one of the following codes depending on the level of risk. This code must be displayed on the medicine label.

AUST L (listed) – These products make low-level health claims and contain pre-approved low-risk ingredients. They are reviewed for safety and quality only, not for how well they work. Products in this category include sunscreen, vitamin and mineral supplements, and herbal medicines. These products are available at supermarkets, health food stores and pharmacies, and you don’t need a prescription.

AUST L(A) (assessed listed) – These products make higher-level health claims than other listed medicines and contain pre-approved ingredients. The TGA assesses them for safety, quality and whether the scientific evidence shows that the product does what it says it does. These products may include the “TGA assessed” symbol on the label and are sold at pharmacies, supermarkets and health food stores.

AUST R (registered) – Because these products are considered higher risk, they are evaluated by the TGA for safety, quality and whether the scientific evidence shows that the medicine does what it claims. They include all prescription medicines, most over-the-counter medicines and some higher-risk complementary medicines. Registered complementary medicines may include the “TGA assessed” symbol on the label.

Many pharmacies and health food stores sell herbal preparations. For more information on the safety, labelling and regulation of these medicines, visit the Therapeutic Goods Administration.

Some complementary therapists are required to be registered and accredited, but most are unregistered.

Registered health practitioners – The Australian Health Practitioner Regulation Agency (AHPRA) and 15 National Boards regulate certain types of health practitioners, such as doctors, nurses, dentists, pharmacists, psychologists, physiotherapists and Chinese medicine practitioners (including acupuncturists).

Health practitioners must meet certain standards before they can be registered and accredited with a National Board. This helps ensure that only trained and competent health professionals practise within these professions. It is unlawful for a person to pretend to be a registered health practitioner. If you have concerns about the performance or conduct of a registered health practitioner, you can contact AHPRA.

Unregistered health practitioners – Some health practitioners are not legally required to be registered with a National Board. They are known as unregistered health practitioners or general health service providers. They may join a professional association that sets minimum standards, but membership is voluntary. In some states, unregistered health practitioners are required to follow a Code of Conduct, which must be displayed in the premises. If you have an issue with an unregistered practitioner, talk to them first. If you’re not satisfied, you can lodge a complaint.

The following complementary therapy providers that are not registered with AHPRA have set up their own regulatory bodies:

Naturopaths and Western herbalists – Most naturopaths and herbalists are members of the Australian Register of Naturopaths and Herbalists (ARONAH). This is a self-governing body that sets minimum standards of practice for both professions.

Homeopaths – The Australian Register of Homoeopaths (AROH) represents homeopaths who are qualified to practise in line with government standards. The AROH outlines the necessary professional standards for registered homeopaths, who must meet continuing education requirements each year.

Because they are not regulated in the same way as doctors, nurses and other registered health practitioners, standards of care may differ from one complementary therapist to another.

If you experience any side effects that you think are from a complementary therapy, stop the treatment and talk to your therapist about your options. These may include adjusting your treatment, stopping the treatment permanently, seeking a second opinion, or seeing another qualified therapist. You can also talk with your doctor or pharmacist about your concerns. If you have a serious reaction, call Triple Zero (000) or go straight to your nearest hospital emergency department.

If you are concerned that a therapist has been negligent, incompetent or unethical, consider the following options:

• If they belong to a professional association, contact the association with a formal complaint.
• Contact the health care complaints commission in your state or territory.

Health care complaints commissions

These organisations protect public health and safety by investigating and resolving complaints about health care providers. They can also prosecute
serious complaints.

ACT – ACT Human Rights Commission ph: 02 6205 2222

NSW – Health Care Complaints Commission ph: 1800 043 159

NT – Health and Community Services Complaints Commission ph: 1800 004 474

QLD – Office of the Health Ombudsman ph: 133 646

SA – Health and Community Services Complaints Commissioner ph: 1800 232 007

TAS – Health Complaints Commissioner Tasmania ph: 1800 001 170

VIC – Health Complaints Commissioner ph: 1300 582 113

WA – Health and Disability Services Complaints Office ph: 08 6551 7600 or 1800 813 583

Weigh up the different types of therapies

• Think about what you expect to gain from using complementary therapies. Which therapies are suitable for treating the issue you want help with?
• Consider possible side effects and safety issues of the different therapies you are interested in. Are there any reasons why you shouldn’t use them?
• Consider whether you prefer to use complementary therapies with strong scientific evidence, or whether anecdotal evidence is enough for you.
• Find out what therapies are offered at your hospital or treatment centre.
• Ask how much the various therapies cost.

Find out more about different therapies

• Gather information about the effectiveness of the therapy. Consider whether the evidence is accurate, up to date, and comes from a reliable source.
• Borrow books from a library or read about therapies on trustworthy websites.
• Ask the therapist about the quality of the product and how it is regulated.
• Talk to other people who have tried these treatments, for example, at a cancer support group or through Cancer Council Online Community.
• Write down any questions.

Discuss your concerns

• Talk to your therapist or doctor about the therapies you would like to try, and whether there are any potential interactions with your conventional treatments or other side effects you should be aware of.
• Get a second opinion if you are not happy with the information you receive.

Call Cancer Council 13 11 20 to find out more about using complementary therapies as part of your cancer care.

Talking with your GP or cancer care team is a good starting point. Your cancer treatment centre may offer some complementary therapies or be able to recommend suitable therapists in your local area. Natural therapy associations often provide directories of therapists. Your family or friends or support group may also be able to recommend a therapist. Some doctors, nurses and pharmacists are also qualified in a complementary therapy, such as nutritional and herbal medicine, hypnotherapy, counselling, acupuncture or massage.

What to consider when choosing a therapist

• Always check the therapist’s qualifications and whether they are a member of a professional association.
• Ask if they have experience treating people with your type of cancer.
• Ask about the cost for each session and how many sessions you are likely to need.
• Ask if they have insurance.
• Confirm that the therapist is willing to communicate with your cancer care team about your conventional treatment, especially if you are using  remedies that may interfere with this treatment.
• Check whether the therapist would like to see a list of the medicines you are taking or your conventional treatment plan. This reduces the risk of
  them dispensing remedies or other treatments that might interact with your conventional treatment.
• Keep a record of the treatments given and medicines or supplements you have been prescribed.
• Take someone with you to appointments to offer support, get involved in the discussion, take notes or simply listen.

How to assess online information

There are 4 key ways to ensure the information you are looking at online is trustworthy:

The source – Is it reputable? Have you seen it before? Is it clear who is providing the information? Check the “About us” section.

The reviewers – Has the information been reviewed by experts with qualifications specifically related to cancer?

The date – When was the information last reviewed? Ideally, it should be within the last 2–3 years.

The claims – Is the website promoting a “miracle cure” or selling something? If it sounds too good to be true, it probably is.

Check with your doctor before trying any new therapy.

One of the reasons people with cancer use complementary therapies is because it helps them take an active role in their health and wellbeing.  However, it is important to discuss ways to manage any symptoms and side effects with your doctors, rather than self-diagnosing.

Some simple ways people can help themselves, without the guidance of a professional, include learning gentle massage or acupressure techniques, adding essential oils to their bath, or meditating.

Some people may consider self-prescribing herbs or nutritional supplements. Although this may seem like a cheaper alternative, it may not be safe. The benefits of seeing a professional complementary therapist are that they:

• are qualified in the therapy or medicine you are considering
• have an objective view of your case
• may be experienced in treating a range of conditions and have treated other people with cancer
• are able to liaise with your cancer specialists, as necessary
• can prepare a tailor-made treatment plan and dispense remedies based on your individual needs, if they are qualified to do so
• can recommend good quality products and how to take them to achieve the desired effect
• can help you avoid the health risks of using complementary therapies that may interact with conventional cancer treatment.

Many websites sell a range of herbs or nutritional supplements that may be less expensive than those you can buy in Australia. However, products purchased from overseas are not covered by the same safety and quality regulations that apply to products sold in Australia. 

Just as you may want to get a second opinion from another cancer specialist about your conventional cancer treatment and medicine, you might want to see a few different complementary therapists to compare how they would approach your therapy.

After consulting with a complementary therapist, you may decide you don’t want to continue seeing them because you are not sure they can offer you the right care for your treatment goals. They may be able to suggest other complementary therapies that would be suitable.

Getting a second opinion can be a valuable part of your overall decision-making process. It can help you feel comfortable about any complementary therapies you choose to have.

Complementary therapists set their own fees for consultations. The cost can vary depending on the training and experience of the therapist, the length of the consultation, the treatment provided, and where you live.

Fees for a private complementary health therapist can range from about $60 to $200 per hour, which may not include the cost of herbal remedies, essential oils, nutritional supplements or other products. Some cancer centres provide free or subsidised complementary therapies to their patients.

Naturopaths, herbalists and homeopaths may dispense remedies that they mix for you, sell you pre-made nutritional, herbal or homeopathic  supplements, or refer you to a naturopathic dispensary to have a script made up. How much you have to pay for these products varies depending on the type of remedy and the ingredients, strength and quantity. Consider speaking to a few therapists to compare costs.

Complementary therapies are not covered by government-funded schemes such as Medicare or the Pharmaceutical Benefits Scheme (PBS). It is important to consider the cost of these therapies if you are thinking about using them.

If you have private health insurance, check whether you are eligible for a rebate on the cost of a consultation with a complementary therapist. Many therapies are not subsidised by private health insurance providers, due to lack of evidence for their effectiveness.

Most health funds also do not provide a rebate on the cost of any remedies or supplements that you buy.

Funding for clinical trials or research into the effectiveness and safety of complementary therapies is limited. Because of the popularity of  complementary therapies in Australia, the NICM Health Research Institute at Western Sydney University was established to promote research in this area of health care.

Some health professionals, universities and hospitals are also involved in research and clinical trials. Your hospital or support group may provide opportunities for you to take part in clinical trials and research involving the use of complementary therapies.

If you join a clinical trial for conventional cancer treatment, it is important to check whether using any complementary therapies could impact on the trial results. Speak to your doctor and/or the trial coordinator for information.

You may find it helpful to talk to your specialist, cancer care team or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time. For more information, call Cancer Council 13 11 20 or visit Australian Clinical Trials.

Download our booklet ‘Understanding Clinical Trials and Research’