Cancer can seem like a hopeless disease. When faced with a diagnosis of cancer, many patients try multiple approaches to wellness. Surveys have found that half or more of patients with cancer have tried complementary or alternative medicine. Patients try everything from acupuncture to yoga to feel healthy, relieve symptoms, reduce side effects of treatments, and treat diseases.
Complementary and alternative medicine (CAM) encompasses hundreds of diverse medical and healthcare systems and practices and thousands of products that are not considered part of conventional medicine. This includes practices such as acupuncture and yoga, herbal medicines, nutritional supplements, homeopathy, and others. CAM treatments are not necessarily proven to work, although some do have evidence backing them up. The list of practices that are considered CAM changes continually as practices and therapies that are proven safe and effective become accepted as mainstream healthcare practices.
Complementary and alternative medicine is defined partly by what it's not: conventional medicine. Conventional medicine is practiced by holders of a M.D. (medical doctor) or D.O. (doctor of osteopathy) degree. Some conventional doctors may also practice complementary or alternative medicine. Conventional medicine may also be called allopathic, western, regular, or mainstream medicine.
The terms complementary and alternative are often used interchangeably, but they are, in fact, two different approaches to the treatment of disease. Complementary medicine is used in addition to conventional medicine; alternative medicine is used in place of conventional medicine. It is highly unlikely that a physician practicing conventional treatment of cancer would recommend a truly alternative treatment. Such a physician might, however, recommend a complementary treatment.
Patients may use complementary approaches for:
- Prevention of disease
- Managing symptoms
- Increasing wellness (quality of life, reported sense of well-being)
- Improving treatment effectiveness
This guide explores how complementary and alternative medicine is used in cancer and some of the questions you might be asking:
- What is complementary/integrative medicine?
- What types of complementary treatments might be used as part of integrative medicine?
- What should I tell my doctor about other therapies I am using?
- How can I tell if a particular therapy is likely to be safe and effective for me?
- Why can't I find CLEAR answers on effectiveness and safety of specific complementary therapies?
- What questions should I ask about a complementary therapy or practitioner?
- Where can I find more information about the safety and effectiveness of other herbal or nonherbal complementary therapies?
A complementary and integrative approach occurs when the patient's doctors know about the complementary care, agree that it will not be harmful, and continue to monitor the patient's progress while keeping an eye on the effects of both the complementary and the conventional therapies. In integrative medicine, practitioners in both areas (conventional and complementary) work together to provide the patient with the safest and most appropriate treatments.
Complementary, alternative, and integrative approaches may include the same therapies—for example, if someone with cancer chooses to be treated by a practitioner of traditional Chinese medicine instead of having conventional cancer treatment, that would be alternative medicine, while someone who has acupuncture to help with the side effects of chemotherapy would be taking a complementary approach.
Physicians who practice integrative medicine focus on the whole person. And, just as they must keep abreast of current research in conventional medicine, they also review the latest research results for complementary therapies. This ensures that the treatments don't conflict with each other and don't cause any harm to the patient.
Complementary and alternative medicine can be divided into five major areas: alternative medical systems such as traditional Chinese medicine, Ayurveda, and homeopathy; mind-body interventions such as guided imagery and hypnosis; biological treatments such as herbal medicines and special diets; manipulative and body-based therapies such as massage; and energy therapies such as Reiki and Qigong.
For any proposed CAM therapy, it is important to consider:
- Safety (appropriateness for particular conditions, producers' quality control for items such as herbal medicines, etc.)
- Cost in time and money in relation to potential benefit
- Credentials of the practitioner
Many patients report that CAM treatments are helpful, but others have found no effects or have reported problems. It is critical that you receive these treatments from qualified practitioners (see question on how to find a qualified practitioner) and that your doctor knows you are participating in these therapies. This is an integrative approach.
While many cancer patients use many different kinds of complementary remedies, these should not be the sole source of treatment. Many of these therapies are only in the beginning stages of being researched and are not cures, while conventional treatments have solid scientific research behind them. And not all complementary treatments can be used with an integrative approach; some may be unsafe, while others may conflict with the conventional therapy a patient is having or be unsuited to that particular person for other reasons.
Detailed information about individual complementary cancer treatments can be found at MDAnderson.org and at some of the other websites listed in the page of resources for finding information on safety and effectiveness.
This section has more information on:
- Alternative medical systems
- Mind-body interventions
- Biological-based treatments (includes herbal/plant and nonplant substances and nutritional practices)
- Manipulative and body-based methods
- Energy therapies
Alternative medical systems are complete systems of theory and practice that have evolved independent of conventional medicine. Many are traditional systems of medicine practiced by cultures around the world, including a number of venerable Asian approaches.
Traditional Chinese and other Asian medicine is organized around balancing qi (pronounced chi), or vital energy. In health, qi is said to be properly balanced; disease is seen as a disturbance of qi. Traditional Asian medicine uses a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and Qigong (for more on Qigong, see the section on energy therapy. Acupuncture involves stimulating specific anatomic points in the body to alter the flow of qi and restore energy balance, usually by puncturing the skin with a needle. Some well-designed studies have shown convincing evidence that acupuncture may be useful for chemotherapy-induced nausea and vomiting, but the qi theory of disease remains unproven.
Ayurveda (pronounced eye yer VAY duh) is India's traditional system of medicine. Ayurveda means "science of life." Ayurvedic medicine is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit and strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing.
Homeopathy and naturopathy are also examples of complete alternative medical systems. Homeopathy is an unconventional western system developed in Germany around 1800. It is based on the principle that "like cures like," i.e., that the same substance that produces symptoms when taken in large doses can cure it when taken in tiny doses—the more dilute the remedy, the greater its potency. Therefore, homeopaths use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Critics of homeopathy object that the materials are diluted so much that the treatments are essentially water.
People who practice naturopathy view disease as a disturbance in the body's natural healing processes. Naturopathy emphasizes restoring health rather than treating disease. Naturopathic physicians employ an array of healing practices, including diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of application), spinal and soft-tissue manipulation, physical therapy with electrical currents, ultrasound, and light therapy, therapeutic counseling, and medicines.
Other traditional medical systems have been developed by Native American, Australian Aboriginal, African, Middle-Eastern, Tibetan, and Central and South American cultures.
Many alternative medical systems use heavy metals (also used in conventional medicine) which can be dangerous, especially to children. For this reason, it is critical that only qualified practitioners are consulted and that conventional physicians are informed of their use.
Mind-body interventions use techniques that are meant to help the mind affect bodily function and symptoms.
Many mind-body interventions have a well-documented theoretical basis and a record of success, and some are no longer considered CAM. This includes cognitive-behavioral therapy, an approach in which therapists work with people to correct destructive feelings and behaviors and is widely used to treat conditions such as depression and other self-defeating behaviors.
Mind-body interventions that are still considered complementary and alternative include meditation, certain uses of hypnosis, dance, music therapy, art therapy, prayer, and mental healing. In the case of cancer, these therapies will probably not shrink your tumor, but people use them to feel better and to improve general quality of life during and after treatment.
Energy therapies can also be considered mind-body therapies. Read more about them in the section on energy therapies. Examples include Qigong, Reiki, and therapeutic touch.
Biological-based therapies sometimes include herbs, special diets, and other biological-based therapies. Some dietary supplements, such as calcium for osteoporosis and multivitamins for general health, are sometimes recommended by conventional doctors.
Herbal therapies employ individual or mixtures of herbs for therapeutic value. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Some herbs and other plants may be useful for people with cancer; in fact, over 60 percent of the current chemotherapies for cancer were developed from plants. Examples include vincristine (from a species of the periwinkle plant), etoposide (from the mayapple plant), and Taxol (from the yew tree). However, the fact that a therapy comes from a plant is no guarantee that it is safe or effective. Plants make many compounds; some have no medicinal effect, some are poisonous, and some are merely tasty.
People with cancer may use many different herbs and other plants. Examples include green tea, garlic, curcumin (derived from the turmeric root), and traditional Chinese herbal medicines. The many herbal medicines used for cancer are not listed here, but you can find information on their safety and effectiveness at the sites listed in this section.
There is some evidence in the research that special diet therapies, such as those proposed by Drs. Dean Ornish, Nathan Pritikin, and Andrew Weil, may prevent and/or control illness as well as promote health. Diets commonly recommended to patients with cancer may require that you avoid foods that are thought to make cancer worse, require the addition of extra foods, or simply require changes in food habits. Special diets may be recommended by practitioners, websites, or friends, but should always be discussed with your physician and/or a clinical dietitian.
Orthomolecular and other nutritional therapies aim to treat cancer and other diseases with elements such as magnesium, melatonin, and megadoses of vitamins. Also, vitamins that are within conventional guidelines may be recommended as part of general guidelines on nutrition.
Other biological therapies include the use of laetrile, which is a substance extracted from the kernel within the pit of apricots and other stone fruits, and shark cartilage. In large clinical trials, laetrile was not found to be effective against cancer; in fact, those who took it did worse. Laetrile has been associated with cyanide poisoning. Shark cartilage is currently being investigated in a large clinical trial, and the results are pending.
Many of these biological therapies are useful for managing the side effects of conventional treatments (chemotherapy and radiation) such as nausea, pain, radiation burns, etc. However, some herbs and other biological therapies may enhance or even disrupt the effects of conventional treatments and therefore must be monitored by a knowledgeable physician and/or other healthcare professional. It is very important to tell your doctor about any drugs, herbs, or other products and therapies you are using.
Some methods based on manipulation or movement of the body fall under CAM. For example, chiropractors focus on the relationship between structures of the body—primarily the spine—and how the body functions. They physically adjust the body in order to preserve and restore health.
Osteopaths—doctors of conventional medicine who have a D.O. degree instead of an M.D.—place particular emphasis on the musculoskeletal system. They believe that all of the body's systems work together, so disturbances in one system can affect what goes on elsewhere in the body. In addition to conventional medical practice, they also practice osteopathic manipulation. Osteopaths use their hands as a primary tool to diagnose and treat illness and injury. They examine joints, tendons, ligaments, and muscles for pain and restriction during motion that could signal an injury or impaired function. A patient with cancer might pick an osteopathic doctor over a medical doctor to help with pain, but probably would not pick an osteopathic doctor for overall cancer treatment.
Massage therapists manipulate the soft tissues of the body to improve circulation and relax tense muscles. While body manipulation cannot make tumors go away, many cancer patients find that careful massage—the therapist must know about your cancer—can help them relax or relieve side effects of cancer treatments such as lymphedema (a fluid buildup after the removal of lymph nodes), tense neck and shoulder muscles, backaches, aching legs, etc. Be sure that the massage therapist is aware that you are a cancer patient because manipulation at the wrong time or of the wrong area may cause complications.
Energy therapies focus either on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Some cancer patients report an improved sense of well-being with these therapies.
Biofield therapies are based on the unproven existence of energy fields that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by touching the body or by placing the hands in or through these fields. Examples include Qigong, Reiki, and therapeutic touch.
Qigong is a component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, to improve blood circulation, and to enhance immune function. Qigong is closely related to Tai Chi. Both involve slow, flowing movements coupled with careful breathing.
Reiki is a practice developed in Japan around 1900. The word means "universal life energy," and the practice is based on the belief that the practitioner can channel spiritual energy through his or her own body into the patient's body to heal the spirit, which in turn heals the physical body.
Therapeutic touch is derived from the ancient technique of "laying-on of hands" and is based on the premise that the therapist's healing force affects the patient's recovery; practitioners believe that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers say they can identify energy imbalances.
Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as low voltage pulsed fields, magnetic fields, or alternating current or direct currents to, for example, treat asthma or cancer, or manage pain and migraine headaches.
Although some patients with cancer are known to have used these therapies to treat their disease, no evidence of their effectiveness has been reported in the scientific literature.
Tell your doctor about any substances that you are taking including:
- medicines prescribed by another physician
- over-the-counter (OTC) conventional medicines
- herbal or other nonconventional medicines
- vitamin-mineral substances
Even therapies that sound "natural" can interact with other drugs, increase the risks of surgery, or cause unwanted side effects, so it is crucial for your doctor to know about everything you are taking. If you are taking an herb or other supplement that you have chosen to buy on your own, ask your doctor if there are any potential interactions with your current medications. You may also want to ask for a referral to a dietitian who can help you evaluate the contribution of these supplements to your usual diet.
Also let your doctor know about:
- dietary changes
- exercise or massage
- mind/body therapies
- acupuncture therapies
- energy therapies (therapeutic touch, Reiki, or healing touch)
- other CAM therapies that you add to your care
Just as you would inform your primary care doctor that you are seeing a specialist, you should also inform your oncologist and other doctors if you are seeing a complementary medicine practitioner. Anytime you are seeing more than one healthcare professional, it is best to make them aware of additional treatment plans you may be participating in or considering.
Although many patients do not discuss CAM use with their doctor for fear that the doctor will scoff at the idea and try to talk them out of it, one study found that the No. 1 reason patients don't discuss CAM with their doctor is because the doctor never asked about it. If you are using complementary treatments, it is your responsibility to bring this to the attention of your physician.
Before you talk to your doctor, print information from reputable sites about the treatment you are considering. Give the information to your doctor, give him the chance to review it, and ask for his opinion on whether it will be helpful or harmful. He may not be sure or may recommend not trying the treatment. If the doctor's response is dismissive, tell him you would like to make an informed decision and ask if he would investigate the possibilities further. Or you could refer him to a program in integrative medicine where a physician could guide him in using complementary treatment along with conventional treatment.
It can be difficult to evaluate the safety and effectiveness of a particular therapy for you and your disease. The Internet is full of conflicting information, individual people's testimonials, and websites put out by companies about their own products. Part of the problem is that many products have had little conclusive research done on them, so it is hard for anyone to tell if they work or not, or if they're safe or not.
Here are some steps you can take to find information on therapies you are considering.
- Read the reviews of safety and effectiveness on the authoritative websites of this list.
- Tell your physician and other healthcare team members about the therapy you are interested in and have an open discussion regarding its use. For more information about discussing alternative therapies with your doctor, see the section on what to tell your doctor. You may also want to bring them information from the authoritative websites.
- Take into account both the financial costs and the costs in terms of time to receive the treatment, and weigh those against the potential benefits.
- Carefully weigh the likelihood that the therapy will work against any possible dangers and side effects.
- Check for third-party testing of any herbs, supplements, or other ingestible products that you are thinking about using. Consumer Lab provides information about specific products that have passed its tests, but lists of those that have not passed are only available by subscription. Some labels indicate that the product has passed voluntary testing. A "USP" label means the product has passed testing by U.S. Pharmacopeia. Some products have "NNFA" or "NSF" labels, indicating some third-party testing. The Food and Drug Administration website may have warnings about specific products, but just because something doesn't have a warning there doesn't mean it's safe.
You probably can't find clear answers about the effectiveness of particular complementary therapies because much of this research is in the early stages and needs to be repeated in trials with larger numbers of people or better designs. When reading about studies on specific therapies, keep in mind the size of the study, how the participants were chosen, and where it has been published; very small studies are less likely to be reliable than larger studies, and studies that have been published in reputable, peer-reviewed journals can generally be considered more reliable than studies that are unpublished, have only been presented at a conference, or appear only on websites.
Because of the indefinite nature of early research, it is wise to discuss the probable risks and benefits of any particular therapy with your physician or other members of your healthcare team, and also confer with your family or friends or others who have used the therapy. Reading the reviews of safety and effectiveness on the authoritative websites in this list may give you some idea of what is and is not known about any treatments you are considering.
When choosing a CAM practitioner, you will need to learn about his qualifications for practicing this therapy and the safety and effectiveness of the therapy itself. For example, the practitioner may be licensed by the state or certified by a professional organization. Credentials and training required for various healthcare occupations are provided in a searchable database maintained by the U. S. Department of Labor.
A possible list of questions to ask the practitioners:
- What are the training and credentials of the providers? (Who are they licensed by? Who are they certified by? How many years of experience do they have? And so on.)
- What is the treatment? What do I have to do? How long does it take? Does it hurt?
- How will we know if the therapy is working?
- How will we know if the therapy is not working?
- What are the potential side effects?
- Is the provider willing to communicate with my oncologist?
- Are there any potential negative interactions with conventional medicines?
- How much does it cost?
Does the method require that I give up regular medical treatment? If so, be sure to obtain an independent and conventional assessment of whether doing so may reduce your chances for a cure because the cancer is likely to become more advanced during the delay.
Does this treatment have a reasonable chance to:
- Support my immune system or other systems?
- Counteract the cancer?
- Enable the conventional treatments I'm having to work better?
- Relieve my symptoms or the side effects of conventional treatments?
- How do you know?
Does the provider believe in this treatment because he/she has seen benefits with similar patients?
- If so, would it be possible to speak to some of these patients?
Can the provider give you any references published by peer-reviewed medical or other scientific journals? Peer-reviewed journals require articles to be reviewed by other people in the field to ensure the research meets scientific standards.
If the practitioner dismisses any of the above-mentioned questions, this is a red flag and you should consider someone else.
Where can I find more information about the SAFETY and EFFECTIVENESS of other herbal or nonherbal complementary therapies?
There are thousands of websites that provide information on complementary cancer treatments. However, when looking for information, you should refer only to those sites that do comprehensive reviews of the published literature and have current and accurate information.
Be wary of sites that:
- report only testimonial evidence from former users
- are promoting a particular product
- are promotions by manufacturers of the product
- refer only to research done by their own company
When referring to websites, try to be sure that they are authoritative and that the information provided is based on sound evidence.
Reading reports on medical research can be quite difficult. You may wish to refer to the National Cancer Institute's (NCI) Dictionary of Cancer Terms.
Evidence about effectiveness and safety of both herbal and nonherbal complementary therapies may be found at the following authoritative public websites:
- The University of Texas M. D. Anderson Cancer Center Complementary/Integrative Medicine Education Resources (CIMER) provides detailed scientific reviews of complementary and alternative therapies from aloe vera to Qigong. The site gives information to physicians and other healthcare professionals, the public, and patients to improve the lives of those who choose to use complementary and alternative therapies under the direction of informed physicians. Some pages are available in Spanish and Chinese. The site also includes information on how to communicate with your physician about CAM and an online lecture series featuring leaders in the field of integrative medicine.
- American Cancer Society. This respected organization provides summaries of information about many complementary and alternative therapies that are based on reliable and authoritative resources.
- The National Center for Complementary and Alternative Medicine. NCCAM is part of the National Institutes of Health (NIH) and is the Federal Government's lead agency for scientific research on complementary and alternative medicine. NCCAM funds research, trains researchers, and provides authoritative information through their website, including a lecture series, an information clearinghouse, [not relevant to patients] and publication databases.
- The National Cancer Institute's physician data query database contains peer-reviewed summaries on complementary and alternative medicine, along with conventional cancer treatment, screening, prevention, genetics, and supportive care. The summaries contain information about the treatments, their development, how they are thought to work, and relevant laboratory, animal, and clinical studies. Most of the summaries of complementary and alternative therapies are presented in nontechnical language and are easy to understand. There are more technical versions for health professionals. Both include glossary links to scientific terms. The PDQ database has a list of more than 4,000 open cancer clinical trials from around the world (and 15,000 trials that are no longer enrolling patients) and instructions on how to search for a particular trial. It also provides information on physicians and other cancer treatment-related organizations.
- Memorial/Sloan Kettering Cancer Center provides clinical summaries for many complementary therapies, including details about ingredients, adverse effects, interactions with other drugs, and potential benefits or problems. Evaluations of alternative cancer therapies and products for sexual dysfunction are included. A special version of each monograph investigates the often confusing claims made for over-the-counter products and regimens. News and safety alerts, information for pediatric patients, clinical trials, and classes and workshops that are offered are also included.
- Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition regulates dietary supplements under a different set of regulations from those covering "conventional" foods and drugs. This site includes warning and safety information, adverse event reporting, industry information, labeling regulations, consumer education, and other information, including who is responsible for the safety of supplements and how safety is monitored.
- Credentialing of healthcare practitioners: The U.S. Department of Labor Bureau of Labor Statistics Occupational Outlook Handbook. This government agency lists the training and education needed for healthcare and other occupations. Additional information about standards may be found at individual professional association websites.
This section also contains information on subscription websites.
Where can I find more information about the SAFETY and EFFECTIVENESS of other herbal or nonherbal complementary therapies? Subscription-only websites
These sites also provide information on complementary and alternative cancer treatments. However, they are only available to subscribers. Many hospitals provide free access to these sites if you visit their patient libraries. Most of the sites listed below also offer individual subscriptions. Pricing information can be found at the sites' home page.
- Natural Standard was founded by clinicians and researchers to provide high quality, evidence-based information about complementary and alternative therapies. This international, multidisciplinary collaboration includes contributors from more than 100 eminent academic institutions. Natural Standard is not supported by any interest group, professional organization, or product manufacturer. The website has information on herbs, supplements and complementary practices; particular medical conditions; and interactions between treatments. Natural Standard does not sell individual subscriptions to the professional database, but they do have some free information, including electronic newsletters. Individuals can also buy books or versions of the database for handheld or desktop computers.
- The American Botanical Council provides scientifically based and traditional information to promote the responsible use of herbal medicine. This information is published in the journal HerbalGram, The ABC Clinical Guide to Herbs, and other publications. The council's website also includes reviews and critiques of items about herbal medicines that are in both the scientific and the general press.
- Consumer Lab provides independent test results on the components of specific products. The site also has information on recalls and warnings and where to buy products, a natural-products encyclopedia, and news items.
- Natural Medicine Comprehensive Database has a patient-friendly version that is written in nontechnical language. It includes a search for products by brand name and/or ingredients or scientific name. The brand names and product ingredients are linked to a report on the safety and effectiveness of the particular ingredient.
We have provided very general descriptions of the resources listed above. These websites contain many other resources, and the information on the sites can change. It is best to go to the individual sites and browse them to see if they contain what you are looking for before you pay for access.
Last reviewed on 7/21/09
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