The use of complementary medicine in palliative care in France: an observational cross-sectional study

  • Marilene Filbet
  • Janet Schloss
  • Jean-Baptiste Maret
  • Helene Diezel
  • Per J. Palmgren
  • Amie SteelEmail author
Original Article



Palliative care for cancer deals with physical, psychosocial, and spiritual issues faced by cancer patients, their families, communities, and healthcare providers. Research on complementary medicine (CM) use in France is limited despite high rates of reported CM use in other countries including by palliative patients. This study describes the use of CM by individuals receiving palliative care in Lyon, France.


This study employed an observational cross-sectional survey design.


The study was conducted in three palliative care centers in Lyon, France; two tertiary hospitals and one palliative care unit (3 sites). Inpatients and outpatients visiting the palliative care clinic with a primary diagnosis of cancer at each study site were invited to participate.


Of 138 eligible patients, 100 completed the survey (RR 72.4%). The majority (90.7%) reported using CM in the previous 6 months or since their primary cancer diagnosis. Participant CM use was either the same (20.7%) or increased since their primary cancer diagnosis (33.7%). Average out-of-pocket expenses associated with CM use in the previous 6 months or since diagnosis were €157.40 (SD €330.15). The most common CM health professional visited was an aromatherapist (72.7%), a Coupeurs de feu (38.6%), osteopath (28.6%) and naturopath (15.3%). The most common CM used were aromatherapy oils (33.7%), homeopathy (30.0%), and vitamins (29.4%).


This second survey on CM use in France; is the first conducted in palliative care centers. Results show people with cancer in Lyon, France, have a very high prevalence of CM utilization.


Palliative care Complementary therapies France Health services 



The authors would like to thank the clinical staff at Lyon Sud and Lyon Nord and the palliative care unit at the Red Cross for their valuable contribution to this study.

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ contributions

JS, HD, and AS contributed to the conception, study design, data collection, analysis and interpretation, and drafting of the manuscript. MF and PJP contributed to the conception, study design, data interpretation, drafting, and critical revision of the paper. JBM was engaged in data collection, interpretation of data, and critical revision of the paper. All authors approved the final version of the manuscript.

Compliance with ethical standards

Ethics approval and consent to participate

All the data were handled according to the guidelines set out in the Declaration of Helsinki, and ethical approval to conduct the study was obtained from the [redacted for blinded review]. The participants were informed that participation was voluntary and that they could discontinue their participation at any time. They were also informed that the data collected would be treated confidentially throughout the study. Written informed consent was obtained from all the participants.

Competing interests

The authors declare that they have no competing interests.


  1. 1.
    NIH National Cancer Institute 2017. Palliative care in cancer. [cited 2019 5 Aug]; Available from:
  2. 2.
    World Health Organization 1990, Cancer pain relief and palliative care: report of a WHO expert committee [meeting held in Geneva from 3 to 10 July 1989]. Google Scholar
  3. 3.
    Murray SA, Kendall M, Boyd K, Sheikh A (2005) Illness trajectories and palliative care. BMJ 330(7498):1007–1011PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    World Health Organisation 2019. Cancer. [cited 2019 5 Aug]; Available from:
  5. 5.
    Organization, W.H 2014., Global atlas of palliative care at the end of life. World Wide Palliative Care Alliance & World Health Organization,Google Scholar
  6. 6.
    European Commission 2016. Cancer statistics. eurostat Statistics Explained [cited 2019 5 Aug]; Available from:
  7. 7.
    Joussellin C, Silove L (2016) A new national plan for palliative care raises high hopes in France. Eur J Palliat Care 23(2):101–103Google Scholar
  8. 8.
    Shiel WC 2019. Medical definition of complementary medicine. [cited 2019 5 Aug]; Available from:
  9. 9.
    Coelho A, Parola V, Cardoso D, Bravo ME, Apóstolo J (2017) Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review. JBI Database System Rev Implement Rep 15(7):1867–1904PubMedCrossRefGoogle Scholar
  10. 10.
    Wu X et al (2015) Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Sci Rep 5:16776PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Chung VC et al (2016) Chinese herbal medicine for symptom management in cancer palliative care: systematic review and meta-analysis. Medicine 95(7)Google Scholar
  12. 12.
    Cramer H et al (2012) Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer 12(1):412PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Dhruva A et al (2012) Yoga breathing for cancer chemotherapy–associated symptoms and quality of life: results of a pilot randomized controlled trial. J Altern Complement Med 18(5):473–479PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Seely D et al (2012) Melatonin as adjuvant cancer care with and without chemotherapy: a systematic review and meta-analysis of randomized trials. Integra Cancer Ther 11(4):293–303CrossRefGoogle Scholar
  15. 15.
    Flower G, Fritz H, Balneaves LG, Verma S, Skidmore B, Fernandes R, Kennedy D, Cooley K, Wong R, Sagar S, Fergusson D, Seely D (2014) Flax and breast cancer: a systematic review. Integra Cancer Ther 13(3):181–192CrossRefGoogle Scholar
  16. 16.
    Fritz H, Kennedy DA, Ishii M, Fergusson D, Fernandes R, Cooley K, Seely D (2015) Polysaccharide K and Coriolus versicolor extracts for lung cancer: a systematic review. Integra Cancer Ther 14(3):201–211CrossRefGoogle Scholar
  17. 17.
    Schloss JM, Colosimo M, Airey C, Masci P, Linnane AW, Vitetta L (2017) A randomised, placebo-controlled trial assessing the efficacy of an oral B group vitamin in preventing the development of chemotherapy-induced peripheral neuropathy (CIPN). Support Care Cancer 25(1):195–204PubMedCrossRefGoogle Scholar
  18. 18.
    Kienle GS, Kiene H (2010) Influence of Viscum album L (European mistletoe) extracts on quality of life in cancer patients: a systematic review of controlled clinical studies. Integra Cancer Ther 9(2):142–157CrossRefGoogle Scholar
  19. 19.
    Molassiotis A, Fernández-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E (2005) Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 16(4):655–663PubMedCrossRefGoogle Scholar
  20. 20.
    Träger-Maury S, Tournigand C, Maindrault-Goebel F, Afchain P, de Gramont A, Garcia-Larnicol ML, Gervais H, Louvet C (2007) Use of complementary medicine by cancer patients in a French oncology department. Bull Cancer 94(11):1017–1025PubMedGoogle Scholar
  21. 21.
    Morisson J 2016. Les Coupeurs de Feu a l’Hopital. [cited 2019 5 Aug]; Available from:
  22. 22.
    Foley H, Steel A (2017) The nexus between patient-centered care and complementary medicine: allies in the era of chronic disease? J Altern Complement Med 23:158–163PubMedCrossRefGoogle Scholar
  23. 23.
    Foley H, Steel A (2016) Patient perceptions of clinical care in complementary medicine: a systematic review of the consultation experience. Patient Educ Couns 100:212–223PubMedCrossRefGoogle Scholar
  24. 24.
    Foley H, Steel A (2017) Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: a cross-sectional study. Adv Integra Med 4:22–30CrossRefGoogle Scholar
  25. 25.
    Women’s Health Australia 2012. Australian longitudinal study on women’s health. 06/11/2012]; Available from:
  26. 26.
    Steel A et al (2018) Complementary medicine use in the Australian population: results of a nationally-representative cross-sectional survey. Sci Rep 8(1):17325PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Keene MR, Heslop IM, Sabesan SS, Glass BD (2019) Complementary and alternative medicine use in cancer: a systematic review. Complement Ther Clin Pract 35:33–47PubMedCrossRefGoogle Scholar
  28. 28.
    Berretta M, Della Pepa C, Tralongo P, Fulvi A, Martellotta F, Lleshi A, Nasti G, Fisichella R, Romano C, de Divitiis C, Taibi R, Fiorica F, di Francia R, di Mari A, del Pup L, Crispo A, de Paoli P, Santorelli A, Quagliariello V, Iaffaioli RV, Tirelli U, Facchini G (2017) Use of Complementary and Alternative Medicine (CAM) in cancer patients: an Italian multicenter survey. Oncotarget 8(15):24401–24414PubMedCrossRefGoogle Scholar
  29. 29.
    Schütze T et al (2016) Use of complementary and alternative medicine by pediatric oncology patients during palliative care. Support Care Cancer 24(7):2869–2875PubMedGoogle Scholar
  30. 30.
    Berger L, Tavares M, Berger B (2013) A Canadian experience of integrating complementary therapy in a hospital palliative care unit. J Palliat Med 16(10):1294–1298PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Brauer JA, el Sehamy A, Metz JM, Mao JJ (2010) Complementary and alternative medicine and supportive care at leading cancer centers: a systematic analysis of websites. J Altern Complement Med 16(2):183–186PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Risberg T, Kolstad A, Bremnes Y, Holte H, Wist EA, Mella O, Klepp O, Wilsgaard T, Cassileth BR (2004) Knowledge of and attitudes toward complementary and alternative therapies: a national multicentre study of oncology professionals in Norway. Eur J Cancer 40(4):529–535PubMedCrossRefGoogle Scholar
  33. 33.
    Muecke R, Paul M, Conrad C, Stoll C, Muenstedt K, Micke O, Prott FJ, Buentzel J, Huebner J, PRIO (Working Group Prevention and Integrative Oncology of the German Cancer Society) (2016) Complementary and alternative medicine in palliative care: a comparison of data from surveys among patients and professionals. Integra Cancer Ther 15(1):10–16CrossRefGoogle Scholar
  34. 34.
    Buckner C et al (2018) Complementary and alternative medicine use in patients before and after a cancer diagnosis. Curr Oncol 25(4):e275PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Link AR et al (2013) Use of self-care and practitioner-based forms of complementary and alternative medicine before and after a diagnosis of breast cancer. Evid Based Complement Alternat Med 2013Google Scholar
  36. 36.
    Gulluoglu BM et al (2008) Patients in northwestern Turkey prefer herbs as complementary medicine after breast cancer diagnosis. Breast Care 3(4):269PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Wardle J, Adams J (2012) Indirect risks of complementary and alternative medicine. In: Traditional, Complementary and Integrative Medicine. Palgrave Macmillan, Hampshire, pp 212–219Google Scholar
  38. 38.
    Foley H, Steel A, Cramer H, Wardle J, Adams J (2019) Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Sci Rep 9(1):1573PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Steel A, Tricou C, Monsarrat T, Ruer M, Deslandes C, Sisoix C, Filbet M (2018) The perceptions and experiences of osteopathic treatment among cancer patients in palliative care: a qualitative study. Support Care Cancer 26(10):3627–3633PubMedCrossRefGoogle Scholar
  40. 40.
    Tisserand, H 2017. Grasse Phyt’Armo - What we learned in France about French Aromatherapy. 2017 [cited 2019 5 Aug]; Available from:
  41. 41.
    Piolot M, Fagot JP, Rivière S, Fagot-Campagna A, Debeugny G, Couzigou P, Alla F (2015) Homeopathy in France in 2011–2012 according to reimbursements in the French national health insurance database (SNIIRAM). Fam Pract 32(4):442–448PubMedGoogle Scholar
  42. 42.
    Trichard M, Lamure E, Chaufferin G (2003) Study of the practice of homeopathic general practitioners in France. Homeopathy 92(03):135–139PubMedCrossRefGoogle Scholar
  43. 43.
    Willsher K (2019) French healthcare system ‘should not fund homeopathy’. In: The Guardian, ParisGoogle Scholar
  44. 44.
    Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, Palmer JL, Cohen L (2013) Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol 31(7):952–960PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Horrigan B et al (2012) Integrative medicine in America—-how integrative medicine is being practiced in clinical centers across the United States. Global Adv Health Med 1(3):18–52CrossRefGoogle Scholar
  46. 46.
    World Naturopathic Federation, Global Naturopathic Regulation. 2018, World Naturopathic Federation: Toronto, OntarioGoogle Scholar
  47. 47.
    Legenne M, Chirac A, Ruer M, Reix F, Filbet M (2015) Perception of naturopathy for female patients with metastatic gynecological cancer: a qualitative study. Palliat Support Care 13(6):1663–1668PubMedCrossRefGoogle Scholar
  48. 48.
    Schloss J, McIntyre E, Steel A, Bradley R, Harnett J, Reid R, Hawrelak J, Goldenberg J, van de Venter C, Cooley K (2019) Lessons from outside and within: exploring advancements in methodology for naturopathic medicine clinical research. J Altern Complement Med 25(2):135–140PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Marvibaigi M et al (2014) Preclinical and clinical effects of mistletoe against breast cancer. Biomed Res Int 2014Google Scholar
  50. 50.
    Heusser P, Kienle GS (2009) Anthroposophic medicine, integrative oncology, and mistletoe therapy of cancer. In: Integrative Oncology, vol 2014, 2nd edn. Oxford University press, New YorkGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Centre de Soins PalliatifsCentre Hospitalier Lyon SudLyon SudFrance
  2. 2.Office of ResearchEndeavour College of Natural HealthBrisbaneAustralia
  3. 3.Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
  4. 4.Australian Research Centre in Complementary and Integrative Medicine, Faculty of HealthUniversity of Technology SydneyUltimoAustralia

Personalised recommendations