Complementary and alternative medicine mention and recommendations are lacking in colon cancer clinical practice guidelines: A systematic review

Background Cancer patients often utilize complementary and alternative medicine (CAM) in hopes that it will treat their disease and improve their physical and emotional well-being; past research has found that up to 80 % of patients diagnosed with colorectal cancer use CAM. Caution must be taken, however, as some CAM therapies can be shown to be detrimental to patient health. This study identified the quantity and quality of recommendations associated with CAM in clinical practice guidelines (CPGs) for the treatment and/or management of colon cancer. Methods A systematic review was conducted to identify colon cancer CPGs. MEDLINE, EMBASE and CINAHL databases along with the National Centre for Complementary and Integrative Health (NCCIH) website were searched from 2008 to October 2018. The Guidelines International Network and the National Centre for Complementary and Integrative Health websites were also searched. It was originally planned that had eligible guidelines been found to contain CAM recommendations, they would have been assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument, however, none were found. Results From 160 unique search results, 8 CPGs were found to be eligible, however, no CPGs were found to make mention of CAM nor provide CAM recommendations. The CPGs found primarily discussed the effectiveness of conventional and adjuvant therapies, providing recommendations surrounding topics such as chemotherapy, radiotherapy, surgery, and the usage of oxaliplatin. Conclusions The quality of CAM versus overall recommendations could not be assessed in CPGs for the treatment and/or management of colon cancer, as no CAM recommendations were found in any of the eligible articles. Given that it is known that a high proportion of patients with colon cancer seek CAM, current colon cancer CPGs’ lack of CAM treatment or management recommendations reflects a large gap in guidance for both clinicians and clinical researchers.