Complementary and alternative medicine status in ovarian cancer guidelines: A systematic review

Introduction Given the often-advanced stage of ovarian cancer upon diagnosis, many patients may seek complementary and alternative medicine (CAM), however, when improperly used, such therapies can be detrimental. Healthcare providers rely on clinical practice guidelines to give evidence-based advice. The objective of this study was to identify the quantity and assess the quality of CAM recommendations in ovarian cancer treatment and/or management in clinical practice guidelines. Methods MEDLINE, EMBASE and CINAHL were systematically searched from 2009 to April 2020, in addition to the Guidelines International Network, the National Center for Complementary and Integrative Health, and Google websites. Had CAM recommendations been found, the guidelines would have been assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Results Fifteen eligible ovarian cancer guidelines were identified from 432 unique search results. No eligible guidelines made mention or recommendations of CAM. The guidelines focused on treatment with conventional therapies including surgery, chemotherapy, and radiation therapy. Conclusion The quality of CAM recommendations in ovarian cancer treatment could not be assessed and compared with overall guideline recommendations. Given that a large proportion of ovarian cancer patients use CAM, this lack of therapy recommendations for the treatment and/or management of ovarian cancer reflects a major knowledge gap. Future guidelines should consider incorporating evidence-based CAM in their recommendations given that clinicians require this information in order to inform important shared-decision making discussions regarding safe and effective CAM use with their patients.