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Alternative remedies for those with no alternative

BACK in 1917, with Australians fighting in France, Palestine and Belgium during World War I, a lovely red brick building with high ceilings and big windows was opened at Melbourne's Austin Hospital, in Heidelberg. The Austin then was for incurables. The building, called Zeltner Hall after its patron Myer Zeltner, a philanthropist and hospital committee member, was conceived as a place for them to rest away from the wards and to be able to sing or read or draw, or watch concerts. The idea was for a pleasant distraction from the circumstances they found themselves in.

The incurables may have had tuberculosis or spinal diseases or syphilis or, indeed, cancer. Zeltner said his recreation room was for their dignity and to help overturn the mindset that because people were so sick they had no hope or purpose. He deemed that care of the spirit and the mind could support care of the body.

Later, in the 1950s, revue shows were held for the patients in the Zeltner ''recreation hall''. With the advance of medical science there were fewer incurables because some diseases deemed a death sentence had become merely chronic. Still, it was an important place at a hospital for the long-term sick.

According to the book by E. W. Gault and Alan Lucas, A Century of Compassion: a History of the Austin Hospital, a ''memorable'' 1950s revue and one that summed up the spirit of the times was The Austin Hayride, set in a jolly farmyard, in which two senior doctors became ''Strawberry the Cow'' in a cow suit.

The authors called these things - the cow suit revue, but more seriously the space and the light and the holistic approach to patient care - the ''lighter and unofficial side of hospital life''.

''It is not difficult to realise how much it was valued by patients spending long days and years within the confines of a hospital,'' they wrote. ''Healthcare implies a concern for the patient's total wellbeing.''


If those ideas sound ahead of their time, especially in mainstream cancer care, they were. But almost a century since they first appeared, hospitals are experiencing a boom in the incorporation of ''complementary'' and even ''alternative'' methods into clinical practices.

Cancer Council Victoria defines complementary treatment as having ''little or no scientific evidence'' but a growing research base. When complementary methods such as acupuncture, aromatherapy, meditation, massage, art therapy or yoga are used in tandem with the three pillars of hospital oncology - radiation, chemotherapy and surgery - it is called ''integrative'' treatment.

The council defines alternative treatment as ''unproven or unconventional''. Examples are ozone therapy, coffee enemas, magnet therapy and high doses of vitamins.

Zeltner Hall is now the Austin's Olivia Newton-John Cancer and Wellness Centre. The hospital's cancer facilities have been revamped, with the centre a small but important part. The centre carries Newton-John's name because the breast cancer survivor, a fund-raiser and patron of the hospital's new cancer wing, wanted holistic care well represented. She swore by it in her own survival. The centre opened this year.

It works like this: cancer patients who visit or stay at the hospital can use the wellness centre to relax (sleep, read, eat, meditate) in attractive, non-medical surroundings, or they can join peer-support activities or therapies designed to supporting their oncology. There's counselling on subjects ranging from relationships, skin and hair care, and diet, to finances and death. Staff also visit the renovated oncology wards at the hospital, but the centre itself is the hub. It even has a kitchen with a communal table to make people feel less like the subjects of a medical experiment and more like human beings.

''Everything about cancer is intensely physical,'' says Lierre Bayley, who is the final stages of oncology for breast cancer at the Austin. She is only 28. ''Like - everything. The blood, the needles. Everything a doctor or nurse does. Coming to the wellness centre was like a breath of fresh air, it's not about physical pain or the physical body. It's about me as a person.''

As their benefits are unproven, the question must be asked: how much have holistic therapies, ideas and concepts crept into traditional cancer treatments - and why?

In light of revelations today that besieged cancer guru Dr Ian Gawler's Gawler Foundation is struggling financially after questions were asked by oncologists about claims he had cured himself, how much has medicine learnt from him and his kind?

In 2015, when the $1 billion Victorian Comprehensive Cancer Centre opens in Parkville - merging expertise from the Peter MacCallum Cancer Centre, the University of Melbourne, Melbourne Health, the Walter and Eliza Hall Institute of Medical Health, the Royal Women's Hospital and the Royal Children's Hospital - it too will have its own wellness centre, a Maggie's Cancer Caring Centre, already used in hospitals in Scotland, England, Hong Kong and Spain and set up very much like the Austin's centre. The first Maggie's (named after Scottish writer and painter and breast cancer victim Maggie Keswick Jencks) opened in Edinburgh in 1996.

The VCCC will be headed by Professor Jim Bishop, AO, also the chair of cancer medicine at the University of Melbourne. ''This will be a quiet, restful and helpful space inside a busy hospital and research facility,'' he says. ''Everyone is pointing to this kind of thing as best practice in modern cancer care.''

Sydney is building one too - at the Royal Prince Alfred Hospital in Camperdown - the Chris O'Brien Lifehouse, named after the former head of the Sydney Cancer Centre who died from a brain tumour in 2009. In Perth, the Sir Charles Gairdner hospital has the SolarisCare wellness centre. Most offer their services for free and are funded by corporate or philanthropic donors.

None of these methods are held up as cures for cancer. But all are offered as support systems that can help patients mentally, emotionally and physically. This might be as simple as massage to relax a patient who is scared of scanning machines or disturbed about needles and chemotherapy. The Austin is a research hospital where medical academics and scientists work alongside clinicians; the VCCC will be the same. What that means is that instead of the benefits of something like acupuncture or meditation staying anecdotal, they can be more easily studied, just like drug regimes and surgical practices are.

A more radical example from a wellness program is art therapy, in which cancer patients draw, paint and sculpt as a way of helping them figure out with therapists how they feel, what they are scared of and what death might mean. Such therapy was central to Lierre Bayley's experience. She had chemotherapy at the Austin for nearly five months and radiation every day for five weeks and is now waiting on surgery. Bayley lives in Northcote and works in retail but used the wellness centre as a second home to save back-and-forth trips. When she discovered art therapy it turned her life around.

''I was sceptical at first,'' she says. ''Colours and shapes … whatever.'' At the first session the art therapist asked her to draw herself and the image was a dark red and brown body made of straight lines and sharp angles. Then she was asked to draw herself as she hoped to be.

''It was blue and coral-coloured,'' she says, ''and softer and more rounded. It was calm. I left that day feeling that I had released something from my body that was holding me back.''

When she had an early appointment (the cancer treatment made her feel ''like a pincushion'') she would use the wellness centre to eat her normal breakfast, which she would bring in, at the kitchen table. ''Some days I wouldn't want to leave,'' Bayley says. ''It was very helpful to just settle and have some time and not have to go straight back out into the world.''

IT'S all about consumer demand, according to Associate Professor Michael Jefford, who holds an array of senior positions within Australia's cancer treatment hierarchy - he's deputy head of oncology at Peter Mac, a senior consultant at the Cancer Council of Victoria, a principal fellow at the University of Melbourne and director of the Australian Cancer Survivorship Centre.

In the United States, the number of hospitals offering complementary and alternative services has tripled since 2000, driven principally by patient demand for low-risk therapies such as massage, guided imagery, meditation and the ''healing touch'' practice known as Reiki, the American Medical News reported late last year, and it's a similar upswing here.

''Consumers have a much greater say in healthcare than they did 50 years ago,'' says Professor Jefford, noting that oncology is itself only 50 years old. ''There has been a maturing in cancer care and oncology but also a difference in the effect the consumer voice has.

''Cancer is not considered a death sentence any more. Expectations change and cancer is now perceived to be a collection of often treatable diseases, so we need to do more than diagnose and give treatment. There's a recognition that treating the tumour is not enough. People want to feel better supported and feel less anxious and distressed through the process.''

He says as consumers have more access to information, their desire to seek different treatments, quackery, or ''dangerous, false claims'' about expensive cures, increases. But so too does proper evidence-based research into previously fringe ideas. He points to a study, published last month in the international Journal of Clinical Oncology, revealing that acupuncture was great for women with breast cancer and cancer-related fatigue, showing that ''physical and mental fatigue, activity, motivation, psychological distress and all domains of quality of life'' had ''significant improvements'' after six weeks.

As well as providing proof, research on fringe medicine can also disprove things. Jefford cites scientific studies into Laetrile (apricot kernels) and shark cartilage - both touted as helpful - that showed they were either toxic or didn't work. He says the study of more complementary and alternative therapies in a scientific way could only be a good thing.

''These treatments may not affect survival but they may help how people are feeling or even reduce symptoms. Chinese medicine, for example, is an area absolutely open for research - the herbs and acupuncture and 'whole system' approach. Surely there is something to be learned from looking over the fence. It doesn't help to dig your heels in and only have one position.''

Yet Emeritus Professor John Dwyer, of the University of New South Wales' school of medicine and the anti-quackery group Friends of Science in Medicine, said the rise in wellness centres was potentially ''disturbing''. They ''should be heavily rooted in evidence-based medicine,'' he says, adding that while there was nothing wrong with the notion of ''wellness'', patients should never be promised anything more than they would in traditional oncology.

''If someone says, 'We are going to put the aroma of daffodil in your room' when you have cancer of the lung 'and it will stimulate this or that to help fight the cancer', then that is not acceptable.''

The director of Melbourne's National Institute of Integrative Medicine, Professor Avni Sali, a pioneer of alternative medicine in Australia and former president of the Gawler Foundation, says what he calls ''peripheral therapies'' are gaining ground in hospitals very quickly, but only in metropolitan Australia, not the regions. ''Some people don't cope with change,'' he says.

His clinic offers thermal cancer therapy or hyperthermia in which tumours are exposed to high temperatures, supposedly making them more vulnerable to radiation and chemotherapy. The clinic also offers thermography or microwave radiometry for cancer, which is a scan to detect cancerous or pre-cancerous activity. Nutrition and exercise are crucial to his approach. ''A healthy cancer patient will live longer than an unhealthy one,'' he says. ''There is no question that these ideas are beginning to be more available at mainstream hospitals.''

Interestingly, most of the new or planned facilities in Australian hospitals have the word ''wellness'' either front-and-centre in their name or prominent in their mission statement. Wellness is about the mind as well as the body and how the two can interact for the better. But cancer is cancer and despite advances in medical science, it is a terrible, insidious disease and, says Professor Jonathan Cebon, medical director of the Austin's cancer services, the prognosis is still grim for many.

''Conventional treatments haven't worked all that well,'' he says. ''So there's a strong attraction for alternatives. A naturopath can say to a patient, 'I can cure you', while the doctor in the hospital says, 'Your hair will fall out, then you will die'. It's obvious why many people stay away from doctors.''

He says the cancer wellness centre at his hospital caters for death as well as life, offering patients counselling and therapies to do with preparing psychologically and emotionally for a good death. ''In palliative care, they will die, but chemotherapy can buy time. Yet the patient may decide on quality of life rather than buying a few extra months because they don't want the toxicity of the treatment. We won't abandon that individual. We will offer supportive care and end-of-life care.''

Professor Cebon says chemotherapy, radiation and surgery will remain the ''model of care'' for cancer.

''We have got the name 'wellness' in the name of centre and we certainly see it as a critical element of the package - but not to the exception of conventional therapy if it is clear that conventional therapy will help the patient.''