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What Is an Exceptional Cancer Trajectory?: Multiple Stakeholder Perspectives on Cancer Trajectories in Relation to Complementary and Alternative Medicine Use

Department of Neurobiology, Care Sciences and Society, Division of Nursing, Unit for Studies of Integrative Health Care, Karolinska Institutet, Stockholm, Sweden

Anette Forss, PhD, RN

Department of Neurobiology, Care Sciences and Society, Division of Nursing, Unit for Studies of Integrative Health Care, Karolinska Institutet, Stockholm, Sweden, anette.forss{at}ki.se, Technoscience Research Group, Department of Philosophy, State University of New York, Stony Brook, NY

Torkel Falkenberg, PhD

Department of Neurobiology, Care Sciences and Society, Division of Nursing, Unit for Studies of Integrative Health Care

Carol Tishelman, PhD, RN

Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden, Research and Development Unit, Stockholm's Sjukhem Foundation, Stockholm, Sweden, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

Background: Although links between exceptional cancer trajectories (ECTs) and complementary and alternative medicines (CAMs) have been suggested, most research on ECT uses predefined criteria for ECTs without necessarily including CAM use. Little knowledge can be found about subjective perspectives of ECTs in relation to CAM. Objectives: This Swedish study explores how patients, significant others, and CAM and biomedical health care (BHC) providers reason about ECT, including the role of CAM. Methods: Using a case study approach, open interviews were conducted with multiple stakeholders about cancer trajectories reported as exceptional. Results: In-depth analysis of 5 cases indicated that although all stakeholders agreed that the reported cases were positive, in no case was the same trajectory considered exceptional by all stakeholders. Different stakeholders shared neither conceptualizations of what constituted an ECT nor attributions for positive trajectories. Patients, significant others, and CAM providers emphasized unexpectedly long survival and well-being in ECTs, whereas BHC providers only referred to survival. CAM and BHC providers normalized reported trajectories, although the forms for this differed between provider groups. Concluding discussion: Stakeholders' accounts are discussed relative to different health care domains, legitimization processes, and legal constraints, which have led to the lack of a public sphere for CAM use in cancer.

Key Words: qualitative methods • case study • interviews • multiple perspectives • complementary and alternative medicine • exceptional trajectories • cancer

Integrative Cancer Therapies, Vol. 8, No. 2, 153-163 (2009)
DOI: 10.1177/1534735409335607


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