J Can Chiropr Assoc. 2020 (Apr); 64 (1): 32-42 ~ FULL TEXT
Maria Tsampika Laoudikou, MChiro, Peter William McCarthy, PhD
Life Chiropractic Clinic.
58 East St, Southend-on-Sea,
Essex, SS2 6LH, United Kingdom
People who have a diagnosis of cancer may develop,
or already have musculoskeletal conditions, just
like any other person. However, discussion about
potential benefits of chiropractic treatment to this
group has generally been avoided related to the fear
of misrepresentation. We aimed to derive a consensus
from a group of experienced chiropractors regarding
their perception of what chiropractic care offered to
patients with cancer. An anonymous, two stage, online,
Delphi process was performed using experienced
chiropractors (n=23: >10 yrs practice experience, who
had treated patients with cancer) purposively selected
and recruited independently. One opted out of the study,
13 actively engaged in two rounds of questions and
verification; agreeing such patients gained benefit from
chiropractic care but use of spinal manipulation was
not essential. There was no clear consensus regarding
a protocol for interaction within any multidisciplinary
team treating the patient. Concerns were raised about
misinterpretation of advertising any benefits for cancer
patients from chiropractic care. Lack of evidence in this
area was acknowledged.
KEYWORDS: cancer, chiropractic, Delphi,
evidence based care, integrated care, manual therapy,
multidisciplinary practice, patient management, spinal
From the FULL TEXT Article:
Cancer is the second leading cause of death globally, accounting
for 8.8 million deaths in 2015.  This disease can
affect almost any part of the body and has many anatomic
and molecular subtypes each requiring specific management
strategies. The greatest step forward in the increasing
success in treatment of this disease has derived from
the improvements in understanding and early detection. [2, 3]
The mixture of diversity of presentation, commonality of
the condition and the rigors of treatment would make it
highly likely that people with such a problem will develop
or exacerbate pre-existing musculoskeletal conditions
and as a result seek care from a manual therapist at some
point in their therapeutic journey. [4–6] It is critically important,
therefore, that a responsible profession has protocols
in place to recognize the possibility of diagnosis, facilitate
access to the appropriate treatment of the condition
by accurate referral or provide musculoskeletal support
within part of an integrated care package for those already
undergoing treatment. [2, 5]
Treatment of patients with cancer is an emotive subject
in complementary and alternative healthcare circles.4
Although treatment of the cancer itself is restricted to
orthodox healthcare by law in many countries, this has
not prevented reports suggesting that other therapeutic
modalities can be used to “cure” the disease.4 Mostly
such claims are based on case reports and literature reviews
and refer to a wide range of Complementary and
Alternative Medicine (CAM) practice, with very little
focus on chiropractic. [7–9] However, this situation has created
a degree of confusion and obfuscation, which has impeded
serious discussion of the potential health benefits
that CAMs such as chiropractic may have on issues such
as the patients’ quality of life. An added problem results
from the difficulty in quantifying the effects of individual
components of any integrated care package as many
are probably indirect benefits loosely associated with recovery
and remission. [8–17] A further reason for not raising
awareness of offering treatment to this group derives from
allegations that CAM practitioners can delay appropriate
access to care by failing to diagnose the metastatic disease
in its early stages. 
It is generally accepted that musculoskeletal symptoms
are common reasons for patients to present to a chiropractic
practice. [19–21] Indeed, the motivations for the patient
with cancer to seek chiropractic care appear to be primarily
the presence of neuro-musculoskeletal symptoms. [22–36]
Occasionally, patients who were unaware that the
underlying cause of their symptoms was cancer present to
manual therapists, on occasion being appropriately diagnosed
and referred. [22, 25. 29, 30, 32. 34, 36–38] Indeed, it is important
to recognize that a number of primary tumours (lung
cancer for example) may initially present with musculoskeletal
symptoms.  The diagnosis of cancer for many
of the above cases was made through a careful history
and physical examination and/ or because the patient was
not responsive to care. [22–38] It is generally considered that
chiropractic education and continued professional development
emphasises the importance of the practitioner
considering progression of severity and/or frequency of
symptoms as the need to trigger re-examination, which
may then warrant further investigation. Additionally, the
education of chiropractors includes extensive training
in the recognition of diagnostic characteristics of various
cancers9, including the use of radiographic imaging,
which can play an important part in confirming the majority
of such diagnoses. [39–41] A driving force for this emphasis
results from the fact that failure to diagnose, make the
appropriate referral, or even the delivery of chiropractic
manipulation when contraindicated could have potentially
fatal consequences for the patient. [41–43]
Patients undergoing treatment for their cancer usually
have to battle both the psychological effects of the diagnosis
and the metabolic effects of the therapeutic approaches;
both of which are likely to increase the likelihood of
musculoskeletal conditions adding to their burden. However,
an analysis of CAM use in Washington, based on the
claims data of two large insurance companies, revealed
a slightly lower proportion of cancer patients (11.6%)
sought chiropractic care when compared to those patients
without a diagnosis of cancer (12.3%).  Although this
change might be considered relatively insignificant, it
does appear to be contrary to expectations based on the
increased depression and anxiety as well as decreased
activity (due to fatigue) that have been associated with
having a diagnosis of cancer: all of which have been associated
with increased musculoskeletal issues. [45, 46] Indeed,
based on this outcome, possibly erroneously, the authors
of that article concluded that spinal manipulation may
not be relevant to patients undertaking cancer treatment.
This perception, whether made by those delivering care or
those requiring care, could be damaging to both the chiropractic
profession and patients if not subjected to further
Although historically treatment plans for patients with
cancer were focused on the disease, recently the importance
of improving the quality of life of the patient has
been recognised.  As a proportion of patients with cancer
do not have significant pain relief with the treatment received,
it would be expected for these people to seek alternative
options of pain relief. Hence, in order to quality
control this aspect of the therapy, the concept of the cancer
rehabilitation team has been developed. This concept
aims at helping with the multidimensional problems faced
by a patient with cancer ; however, interpretations such as
those made from the Washington study  could impact on
the inclusion of certain forms of CAM such as chiropractic
in any integrated care package.
Currently, little information is available regarding
treatment of cancer patients by the chiropractic profession9,
especially in Europe. The authors are aware of one
initiative in the United States where the Cancer Treatment
Centers of America (CTCA) promote themselves as being
part of an integrative care plan adjusted on the needs of
each cancer patient alongside other supportive therapies
such as acupuncture and naturopathic medicine. Although
their project aims to establish a more evidence informed
approach showing how an integrative care plan could be
of benefit for patients with cancer; to the authors’ knowledge,
there is currently no published research underpinning
We therefore chose to initiate our study of this area
by gaining a range of views and maybe consensus from
experienced European chiropractors who had treated patients
with cancer as part of their general practice. The
main issue was whether they considered their treatment
to have benefitted these patients. We also wished to determine
the degree of engagement with the other clinical
disciplines responsible for treating the patient and what
approach they might choose including use of manipulation
and other therapeutic interventions.
Primary aim: to derive a consensus regarding whether
chiropractic treatment was perceived to have any benefit
for patients with cancer.
Secondary aim: to determine if there was consensus of
approach regarding use of chiropractic in an integrated
therapy package, as part of a multidisciplinary clinical
team in the treatment of patients with cancer.
A two-stage Delphi process was performed using a panel
constructed from chiropractors who were members of
the European Chiropractors Union (ECU). A panellist
needed to be a chiropractor with over ten years practice –
based experience, during which time the panellist should
have treated patients who either have or have had cancer.
Members of the panel were purposively selected by a
committee member of the ECU independently of the research
team. The selection brief was to source chiropractors
in practice who complied with the inclusion criteria
and would be interested in participating in this research
process. The panel members were unaware of the names
and locations of the other panel members.
To comply with current European Union legislation,
each potential panel member was asked if they would like
to consider being involved in this process, by giving approval
to pass their email and practice addresses to the research
team. At this point the person was signifying their
interest in principle, without having detailed knowledge
of the topic under investigation.
The contact details of 23 chiropractors were supplied
to the research team who then circulated information detailing
the research topic. At this point, the chiropractors
who had shown an interest were free to choose to respond
to the survey or not. Furthermore, the research team were
not able to determine who had responded and who did
not, which ensured anonymity for the participants. Both
rounds of surveys were delivered to all members of this
group who had not opted out (the panel). Informed consent
was implied through both a statement in the introductory
email text and as warnings given at the start and end
of the questionnaire that submission would be considered
implied consent to use the submitted data.
Panel members each received a personalised email
with the link (active for two weeks) to the questionnaire
that used the SurveyMonkey platform. This e-mail also
contained reminders concerning the implied consent nature
of the questionnaire, anonymity and the right to withdraw
their involvement at any point up to the point they
submitted their completed questionnaire. We also ensured
panel members were aware that they could exit from the
study at any time by simply asking to be removed from
the email list.
The questionnaire mostly comprised free text option
questions. Free text options were chosen to allow the panellists
to include their opinions and experiences as well
their management strategies regarding chiropractic care
of patients with cancer.
The responses were collated and recirculated to the
entire panel at the end of each survey, in order to verify
that the responses and their synthesis were a true reflection
of the panel’s views. Verification was performed by
uploading the summary document to the online platform
(SurveyMonkey) and sending a link to all the panel, giving
them the opportunity to add any further comments anonymously,
if they so wished.
The questions for the second round were developed
based on the responses from the first round, following
verification. The aim of the second round was to delve
deeper into the topic and clarify some of the issues raised
about use of chiropractic treatment on cancer patients.
Those questions were also distributed in the form of a
survey using the same platform (SurveyMonkey). Access
to the second questionnaire was available for four weeks.
A similar verification procedure was completed before the
Ethical approval was granted by the chiropractic
undergraduate research ethics review subgroup (granted
devolved responsibility from the Faculty of Life science
and Education Ethics Committee, University of South
Twenty-three chiropractors were contacted to take part in
the project as part of the panel by the ECU member. One
of them contacted the research team asking more details
about the project and decided to opt out before the release
of the first questionnaire. Thirteen of the 22 remaining
panellists responded to the first questionnaire (59%) with
three contributing to the first verification stage. Thirteen
of the 22 responded to the second-round questionnaire,
with none engaging in the second verification stage. Due
to the anonymity of the respondents, it was not possible
to determine whether the same 13 responded to both questionnaires
or not. Those engaging in the verification did
so only to suggest minor changes.
Demographics of the panel:
Although anonymous, limited information was available
about the 13 panel members (from responses to direct
questions on the questionnaire). Only one had less than
15 years’ experience; the majority (7/13) had between 15
and 20 years’ experience, with five having more than 20
years’ experience. Seven of the panel had studied chiropractic
outside the UK. Details on those who chose to not
to respond was not available.
Areas of unanimous or general agreement:
Of those choosing to respond, it was unanimously agreed
(13/13) that there were benefits that the patient with cancer
could derive from chiropractic care. According to the
majority of the panel (9/13) the perceived benefits were
similar to those recognised and reported by patients without
cancer. The panel unanimously agreed that the role of
chiropractic treatment in patients with a diagnosis with
cancer should not differ from its role for any other patient.
The following were mentioned by at least one of the panel members:
Chiropractic could help a patient with cancer
in terms of their: pain relief, empathy, mobility,
energy levels, quality of life, sleeping patterns and
Perceived benefits of chiropractic care in this
group of patients were reported to include: pain
relief, sleep pattern improvement, immune system
improvement, wellbeing, higher energy levels and
The whole panel agreed that a cancer diagnosis should
make a difference to a chiropractic treatment plan.
The range of reasons given for this included: the
medication used, possibility of metastasis, possible
bone density or ligamentous integrity alterations
due to the cancer. Three of the panel stated
that post-chemotherapy osteoporosis and cancer
diagnosis must be considered a red flag before any
treatment protocol be considered.
All the panel members concurred that SMT should not
be used on all cancer patients. Although the panel stated
that SMT was not considered necessary on all occasions;
it was also stated that SMT should not be contraindicated
in any plan of management. There were a range of different
exclusion criteria offered, the main one being metastasis
(6/13 responses). Other contraindications mentioned
included stage, type and location of the tumour along with
the extent of the area involved, the overall health of the
patient, muscle weakness, atrophy and osteoporosis.
Interestingly, three of the five participants that had been
in practice for 20 or more years and reported seeing 10 or
more patients with cancer a year agreed it was appropriate
to adjust areas other than the involved area, or considered
first treating the patient without SMT if possible. One of
this group reported using only Activator Adjusting Instrument
based techniques on this category of patient.
The reasons that a patient with cancer will visit a chiropractor
were not considered to be different from those of
any other patient namely: musculoskeletal pain/ conditions
(12/13). One panellist reported that
seek chiropractic care for neurological complications affecting
eyesight, balance, dizziness, autonomic nervous
system complications and weakness”.
Additional comments made at the end of the first round
“most patients seek chiropractic treatment after
the cancer was diagnosed” and “the aim should be
the improvement of the function of the patient and that
multidisciplinary patient centred approach could benefit
patients with cancer”.
Three of the panellists stated that chiropractors should
not treat the cancer but address the neuro-musculoskeletal
problems of the patient and help them by improving their
A further panellist stated:
“patients with cancer may
benefit from chiropractors and a vitalistic approach as
long as it is as part of multidisciplinary management.
Contraindications must be considered and weeded out
very carefully. Specific chiropractic spinal manipulation
guidelines must be determined, and all of the healthcare
providers must work together in a patient-centred manner”.
The areas of concern raised by the panel included:
a lack of evidence: 8 panellists considered there
was insufficient evidence to support the safety of
chiropractic on patients with cancer, whereas 2
considered that there was. Additionally, one panellist
outlined that there is enough evidence for safe
chiropractic care in special populations like osteoporotic
patients as the worry was instability or bone
weakening; therefore one could extrapolate that
there would be a good safety record for cancer patients
a lack of communication with the medical team:
part of the panel acknowledged that they do not
communicate with the medical team (7/13). The
situation with the remaining respondents (6/13)
was not clear.
a fear of the misconception that chiropractic cures
cancer instead of helping the neuro-musculoskeletal
aspect of the symptoms associated with the disease
or its treatment.
Throughout their comments
the panellists were continually underlining the
need of giving a clear message that the chiropractor
would not cure the cancer but only help with the
MSK symptoms associated with it.
a lack of specific chiropractic techniques other than
spinal manipulation therapy. Two of the thirteen
actively engaged panel members suggested soft
tissue work, a further two stated there was nothing
specific to chiropractic and seven gave no answer.
Interestingly two panellists replied that they use
SMT if indicated and would apply SMT in other
areas of the body if required.
chiropractors should not advertise the benefits of
their care. One respondent said that such advertising
was not legal in their country of practice,
as new rules are limiting medical advertisement,
whereas the others could not find any reason to target
advertisements towards patients with cancer. In
the comment field, two other panellists stated that
chiropractors should not advertise any treatments
specifically for cancer patients as either cancer patients
are to be seen as any other patient with neuro-
musculoskeletal problems or because an advertisement
like that could “make things worse”. Two
of the panellists responded in the comment field
requesting this section be removed as there was no
option not to answer.
Regarding whether chiropractic as a profession should
do more to advertise the benefits of chiropractic on patients
with cancer, two of the12 who responded agreed
and 10 disagreed. Reasons for disagreeing were that cancer
patients are not and should not be a chiropractor’s primary
patient (n=1), and there is insufficient evidence to
claim that chiropractic could benefit these patients (n=1).
Again, the comments focussed on the possibility of the
message being misconstrued as being the chiropractor is
able to cure cancer, instead of that chiropractic can help
the MSK aspect of the patient’s problem.
Treatment modalities used for treating patients who have been given a cancer diagnosis
Regarding whether the presence of a bone tumour could
be a contraindication to SMT: 9/13 agreed and 4/13 disagreed
with the statement. Ruling out presence of metastases
and osteoporotic regions was the main point of
concern. Although there was consensus that SMT could
be used, low force techniques were considered to be safer
(n= 9). Additionally, comments from a panel member (n=
1) indicated there was insufficient information provided
in this question, with the decision being dependent on the
primary tumour location.
While the panel agreed that the SMT does not appear
necessary in the treatment plan of a patient with cancer
(first round question, 13/13 agreed), the same degree of
consensus did not exist when the panel were asked to suggest
alternative treatment methods and comment on which
would be considered specific to chiropractic. Two of the
13 answered that there is nothing specific to chiropractic,
five out of 13 suggested soft tissue work, while one responded
that the question was not clear. Respondents suggested
the following to be alternative chiropractic specific
therapies: dietary advice, adjustments of areas not affected
by the cancer, use of Activator Adjusting instruments,
active mediations, bio resonance, acupuncture, SOT, NUCCA,
N.E.T., SSEP, trains of four, electrostimulation,
Transcranial Magnetic Stimulation, balance training and
Protocol for treating patients who have been given a cancer diagnosis.
Although a large proportion of the respondents tended to
agree on their approach regarding engagement with the
medical team, there were some interesting differences
within the group.
Many of the respondents (11/13) would not consider
contacting the medical team of the patient to request permission
to treat. However, one panellist stated they would
contact the clinical team regardless of whether the patient
was diagnosed with cancer, in chemo- or radio-therapy or
Approximately half of the respondents (7/13) considered
that a clinical relationship between the chiropractor
and the oncologist was not necessary, while six
of 13 considered it to be necessary. Comments within
the responses to this question showed some differences
in terms of type of interaction. Two of nine who commented
directly, stated that either oncologists are not open
to chiropractic care in the country of practice (n= 1), or
that the oncologist does not know what a chiropractor is
or could do (n= 1).
Comments supportive of a multidisciplinary approach
came from six of the 13 panel members. These are best
encapsulated in the following statement: all healthcare
practitioners working on a patient should have some clinical
relationship for the benefit of the patient and that the
patients’ optimal management is based on a mutual understanding
of each practitioners’ role. Finally, 11/13 of the
actively engaged panel agreed that a chiropractor should
offer treatment to a patient who has a current diagnosis of
cancer; however, two disagreed.
There was unanimous agreement of the panel regarding
the perception that patients with cancer can benefit from
chiropractic treatment. Interestingly, the main reasons that
a patient with cancer seeks chiropractic treatment were
considered by the panel to be no different from those of
any other patient, namely MSK pain and associated disorders.
A better quality of life, pain relief and improved
function were reported to be the most common perceived
benefits of chiropractic in relation to the panels’ experience
with cancer patients.
The panel agreed that a cancer diagnosis should make
a difference to a chiropractic treatment plan, even if the
patient seeks care when in remission. Spinal manipulative
therapy was not reported as being used on all cancer patients,
with exclusion criteria including the location of the
tumour as well as presence of metastases or concurrent
osteoporosis. Type of cancer was not mentioned as a factor
by any of the panel, however, this might relate to the
lack of a specific question.
One of the obvious limitations was that the panellists
only had restricted clinical experience of patients with
cancer, having only encountered them through their own
practices. The potential lack of diversity in terms of the
cancer types seen requires consideration when interpreting
the comments reported here. The fact that these
chiropractors have seen sufficient patients with these conditions
to be comfortable discussing their treatment, however,
does indicate that chiropractors should expect to see
these patients in general practice.
The authors had initially considered a general questionnaire
to the profession; however, a Delphi method
was considered an appropriate starting place to gain some
insight into the issue.
The Delphi method maximizes the benefits of using an
expert/knowledgeable panel while minimizing potential
disadvantages by implementing anonymity. [49–51] Furthermore,
this method allows everything to be performed
by email and does not require the participants to meet
or interact directly. The presence of anonymity allowed
those participating, the room to air their views without
the inhibition that might result when discussing potentially
contentious issues in a direct (face-to-face) social
interaction. This was an important consideration in relation
to approaching this topic area within members of the
chiropractic profession, in order to gather a wide range
of views. Furthermore, anonymity allows decisions to
be evaluated on their merit, rather than being influenced
by the strength of personality (i.e. of the person who had
proposed the idea). Anonymity and confidentiality of participants
are central to ethical research practice in social
Using the Delphi methodology rather than focus groups
allowed information exchange between numerous geographically
(and temporarily) dispersed individuals in an
iterative process. The belief is that there could be benefits
from the exchange of information while retaining a low
cost and convenience of accessing the questionnaires. In
this case, the method allowed chiropractors from across
Europe to answer the questionnaires in their own time
and without awareness of other panel members’ views.
Supplying their responses to a central point and not sharing
them prevented any adverse personal interaction. This
approach has been criticized for limiting the potentially
positive aspects of interaction found in any face-to-face
exchange of information, as these often help identify the
reasons for any disagreements.  The preliminary basis
of this study accepted this minor disadvantage in relation
to the major advantage of determining the nature of the
Consensus development methods are being used to
help clinical guidelines, which define key aspects of the
quality of health care.  However, particularly appropriate
indications/suggestions for interventions, such as those
revealed in this Delphi study, do not represent any clinical
guidelines. Instead, these results should only be considered
as a representation of a consensus between members
of a small panel of European chiropractors regarding
their perspective on chiropractic management of patients
Although 23 potential participants were invited, only
one actively decided to opt out. Of the remaining 22 who
indicated they were interested in participating, slightly
more than half (n=13) actively participated in the first
round. Reassuringly, this level of participation continued
into the second round, however due to the success of the
anonymization process we were not in a position to determine
whether participation was by the same 13 chiropractors
in both rounds. The low response rate during
the verification stages could be considered as reflecting a
general agreement with the conclusions, however as this
was not an active agreement, this can only be considered
tacit approval at best.
Improvements in quality of life, pain relief and function
were the most commonly reported perceived benefits
of chiropractic in regard to patients with cancer. Importantly
making potential patients more aware of these
benefits was not considered appropriate. The debate in
the profession regarding the “philosophy of chiropractic”
seems to have made some chiropractors apprehensive regarding
who they will talk to about chiropractic treatment
in these patients, with the motivation apparently being a
fear of possible misunderstanding about what the chiropractor
could do. Indeed, when presenting our preliminary
analysis at a major European chiropractic meeting
one of the authors found that a number of chiropractic
scientists misinterpreted the aim of the research. A small
number of the panel expressed concerns about advertising
any perceived benefits. Apart from local advertising
restrictions and lack of evidence base, the main concern
was that these patients should not be considered any differently
from patients without a history of cancer, due to
the treatment focus being neuro-musculoskeletal.
The panel agreed that chiropractors should view the
patient as a “whole person” with needs reaching beyond
the management of the disease entity. Indeed, the chiropractic
profession has, ever since its inception, embraced
such a “holistic” approach toward patient care. The generally
accepted primary role of the chiropractor is to assist
the patient with pain management and help the patient to
increase mobility and function beyond a disease diagnosis. [9, 47] The panel did consider that the use of spinal manipulation
might be contraindicated or require careful
consideration when treating patients with cancer. When
challenged regarding alternative management/treatment
tools, the panel reported using a variety of tools, but only a
few of them appeared to be chiropractic specific. The key
feature was that each patient must be evaluated thoroughly
to determine which methods (chiropractic or other) will
provide the greatest benefit in the particular case. In some
instances, treatment may call for non-force techniques,
whereas other situations could be better addressed through
use of more standard manipulative procedures.  Interestingly,
most of the techniques mentioned by the panel did
not appear specific to chiropractic; as a variety of physical
therapists, physiotherapists, osteopaths and sport massage
therapists would also consider them part of their toolbox.
It was agreed by all the panel who expressed an opinion
(n=13) that more evidence would be needed in order for
chiropractic adjustments and chiropractic specific techniques
to be considered safe to use with such patients.
Although the attitude of health care providers and regulators
to chiropractic has been historically negative, the
opinion of the consumers has always been positive. It appears
the public’s opinion of chiropractors does not suffer
because of advertising,48 however it has been suggested
that approval of the majority of clients can be helped by
using a professionally designed and well-conceived advertising
campaign. It has been reported that almost 77%
of the general public seek and want information regarding
the services a chiropractor provides.48 This supports the
need for clarity and transparency when communicating
the identity for chiropractic: as we found here, what a
chiropractor considers specific to chiropractic, may not be
considered to be specific to chiropractors by those outside
The vast majority of the panel agreed that chiropractors
should treat patients with cancer, which provides a positive
answer to the initial question. However, there was a
recognition of the need for evidence to indicate whether
chiropractic treatment is safe for these patients which
was one of the main concerns of the panel. In addition,
the panel struggled to find chiropractic specific management
techniques, which could raise an issue for further
Although anecdotal, there has been the perception of
both fear and confusion in the profession regarding the
role of the chiropractor in the management of patients
with cancer. This was strongly reflected in the comments
made by the panel. Therefore, going forward it is apparent
that evidence will be needed in order to both allay fears,
define roles and facilitate in the engagement of chiropractic
as part of an integrated care package for these patients.
This suggests there may be a need, at least initially, to
create consensus based guidelines (as there is no research
available to currently inform such guidelines) that support
currently considered best practice and prevent more dubious
and unhelpful claims of efficacy.
This research does not present evidence supporting
benefits for patients with cancer from chiropractic care,
or whether spinal manipulative therapy should be used on
the management of patients with a diagnosis of cancer.
However, it does give evidence that experienced chiropractors
both treat such patients and recognise a potential
role for chiropractic in this population of patients.
Chiropractors treat patients who have cancer, seeking care
mainly for neuro-musculoskeletal complaints. Advertising
is not considered viable due to potential for adverse
Further research is necessary regarding initially how
chiropractic could gather data about the relative safety
and risks of chiropractic care in such patients. Chiropractors
need to establish better inter-professional relationships
with the patient’s medical and rehabilitation team.
It is important to send a clear message that chiropractors
do not cure cancer but only aim to help with the neuro-
musculoskeletal signs and symptoms. Therefore, construction
and publication of consensus-based guidelines
of best practice should be considered a priority.
The authors would like to acknowledge the time and contribution made by those chiropractors who responded, without which this study would not have been possible.
List of Abbreviations:
ECU = European Chiropractic Union
WHO = World Health Organization
CAM = Complementary and Alternative Medicine
SMT = Spinal Manipulative Therapy
MSK = Musculoskeletal
The authors have no disclaimers, competing interests, or sources of support or funding to report in the preparation of this manuscript.
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