Complementary and Alternative Medicine
For patients, families, and healthcare workers, navigating through the myriad of available therapies for cancer can be a daunting task. This is made more complex by the inherent heterogeneity in the types and causes of cancer. While traditional (standard) therapies for cancer such as chemotherapy, radiation therapy, and surgery remain the mainstays of cancer treatment, alternative therapies for cancer have garnered interest from all stakeholders for their promise as perhaps not primary but complementary therapies.
There are many terms that describe these alternative therapies, including “holistic”, “complementary”, and “naturopathic”. A commonly used moniker that seems to encompass many of these terms is “Complementary and Alternative Medicine”, also termed “CAM”.
Interestingly, the term CAM seems to be somewhat a paradox. Complementary seems to suggest one therapy in addition to another, while alternative implies one therapy instead of another. Therein may lie some of confusion associated with this term. This confusion contributes to the controversy surrounding the use of CAM in many diseases, including cancer.
Complementary and Alternative Medicine includes such modalities as acupuncture, dietary modification, exercise, hypnosis, and yoga. For example, a very good friend of mine was diagnosed with advanced lymphoma about six months ago. In addition to traditional chemotherapy, he embarked on an aggressive regimen that included dietary optimization (for example, nutritional support), exercise, and positive thinking. This routine accelerated once the chemotherapy began, and even more so in advance of his stem cell (bone marrow) transplant a few weeks ago. While the typical hospital stay after bone marrow transplant is about 30 days, his stay lasted only 12 days. This was a record for the oncology team. Each day I spoke with my friend he sounded buoyed not only by his medical status, but by his general state of well-being. Clearly, the support system he had in place was a major factor spurring his recovery, but he and his medical team cite his pre-treatment regimen as a principal reason for his rapid recovery. Indeed, nutritional optimization is not a radical concept, but an essential predictor of outcome in many chronic diseases. Three days after he left the hospital, he went to visit his sons play hockey several hundred miles from home. While it would be inaccurate to assume that this result could be generalized for all patients, it would also be erroneous to discount the role that CAM played in his recovery from the transplant.
A few weeks ago, a member of our board of directors, Amy Champion, and I, visited some friends at the Johns Hopkins Applied Physics Laboratory (APL) who have developed a cancer support group for fellow employees at APL. It was a suggestion by one of the attendees to explore the topic of CAM in cancer. Among other insights, the attendees all conveyed the difficulty facing patients in determining which therapies are most efficacious while minimizing safety concerns. Therefore, it is vital to ascertain the scientific evidence supporting the role of CAM in total cancer care. It is challenging to arrive at a simple conclusion since some patients, as my friend did, receive a combination of traditional and CAM therapies. A study by Chan et al in Alternative Therapy Health Medicine published in 2012 explored clinical outcomes for patients with cancer receiving either traditional therapy or a combination of traditional plus CAM. They reviewed the records of 357 patients. They found that the patients receiving some degree of CAM had lower infection and hospitalization rates compared to patients who received traditional therapy alone. However, another study by Yun et al in the Journal of Oncology in 2013 evaluated the role of CAM in 481 patients with cancer. Those that received CAM as part of their overall cancer care did not have better survival and demonstrated significantly lower cognitive functioning and fatigue compared with those in whom CAM was not incorporated into their total cancer care.
In view of these two studies that reached very different conclusions, it must be stated that in medicine it is vital to review many studies, so called meta-analyses, to determine the impact of an intervention. I could not find a meta-analysis that would better answer the question of the efficacy and safety of CAM in cancer care.
The experts have provided some assessments of the role of CAM in cancer care. The National Cancer Institute (NCI; https://www.cancer.gov/about-cancer/treatment/cam) states: “Some CAM therapies have undergone careful evaluation and have found to be safe and effective. However, there are others that have been found to be ineffective or possibly harmful. Less is known about many CAM, and research has been slower for a number of reasons. CAM therapies need to be evaluated with the same long and careful research process used to evaluate standard treatments. Many of these “natural” [vitamins, herbal supplements] products are considered to be safe because they are present in, or produced by, nature. However, that is not true in all cases. In addition, some may affect how well other medicines work in your body. Tell your doctor if you’re taking any dietary supplements, no matter how safe you think they are. Even though there may be ads or claims that something has been used for years, they do not prove that it’s safe or effective. Supplements do not have to be approved by the federal government before being sold to the public.” The Mayo Clinic website (http://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-treatment/art-20047246) lists ten alternative therapies that “may provide some benefit”, including exercise, massage, relaxation techniques, yoga, acupuncture, aromatherapy, hypnosis, music therapy, meditation, and tai chi. They add: “Alternative cancer treatments may not play a direct role in curing your cancer, but they may help you cope with signs and symptoms caused by cancer and cancer treatments. Integrating the best of evidence-based complementary and alternative cancer treatments with the treatments you receive from your doctor may help relieve many of the symptoms associated with cancer and its treatment. Work closely with your doctor to determine the right balance between traditional medicines and alternative cancer treatments. While complementary and alternative cancer treatments, such as acupuncture, may reduce nausea or pain, they generally aren’t powerful enough to replace cancer medications from your doctor.” The NCI and the National Center for Complementary and Integrative Health are sponsoring or co-sponsoring many clinical trials to assess the efficacy and safety of CAM in cancer care.
In conclusion, many components of CAM such as yoga and meditation seem to be straightforward and safe adjuncts to traditional cancer therapy. It seems prudent to separate these therapies from alternative therapies such as vitamin and herbal supplementation that have not been adequately studied and may interfere with standard cancer care. Patients should work with their medical team to discuss the role of an integrative medicine approach that includes traditional or standard cancer care medicine with CAM.