Complementary and Alternative Medicine: An Introduction for Patients

Lara Bonner Millar, MD & Terry Styles, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: February 20, 2013

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Defining the Terms

What is alternative medicine? How about complementary treatments or integrative treatments? Is this conventional medicine? How about unconventional treatments? These terms are often used without explaining the definitions. With the increased popularity of unconventional medical treatments, these terms are being used more and more. Here is a guide to help with the confusing jargon.

Conventional cancer therapies consist of those forms of cancer treatment that are widely practiced and have been proven beneficial in clinical research trials. These may include surgery, chemotherapy, radiation therapy, and/or hormonal therapy. These treatments are used in mainstream cancer centers throughout the world.

Unconventional cancer therapies are basically any approaches to the diagnosis, treatment, and care of the cancer patient that fall outside conventional cancer treatments. Often, these are therapies not routinely taught in medical schools. Many different categories of unconventional therapies have been described including psychological techniques, specialized diets, herbal therapies, spiritual healers, traditional cultural techniques, and pharmacological treatments. While some of the therapies may have efficacy, many of the therapies have not had rigorous testing, others have been proven ineffective and others interfere with conventional treatments. These therapies fall under two categories these are complementary and alternative.

Complementary cancer treatments are those unconventional cancer therapies used in conjunction with conventional medical treatments. Sometimes the termIntegrative Oncology is used to refer to the use of unconventional and conventional treatments together. The value of combining these therapies is being investigated at many centers and through The National Center for Complementary and Alternative Medicine (NCCAM). Some treatments have shown value in helping patients with the side effects of their conventional medical treatments (such as acupuncture and guided imagery used for nausea caused by chemotherapy). Others are being evaluated for their benefit in preventing cancer or increasing the chance of cure when used in combination with conventional therapies.

Alternative cancer treatments ( or alternative medicine) are those unconventional cancer therapies that are used instead of conventional medical therapies. These therapies may report individual patients who have been cured with their treatment, however rigorous trials proving their benefit for the majority of patients are not available.

If you are considering unconventional medical treatments, it is very important that you discuss them with your physician. Although these can be helpful, many can interact with your body or your medications and make it difficult for you to complete your conventional medical treatments that have been proven to cure cancer.

What is considered CAM?

CAM can be broken down into two broad categories I) those that are ingested or injected and II) those that require a practitioner or therapist. Herbals, vitamins, organics, chemicals and diet are examples of the first group and meditation, massage, chiropractic, acupuncture, body-mind therapy, Reiki and prayer are examples of the second. The use of complementary and alternative medicine (CAM) has become the norm for many cancer patients, the majority of whom use it along with conventional therapy. According to the 2007 National Health Interview Survey, 38% of Americans use CAM. Other surveys of cancer patients demonstrate approximately two-thirds are engaged in a least one form of CAM therapy.

What will my doctor think?

As a group, physicians are not always aware of patients' use of CAM therapies. In multiple surveys, only about one-half of patients using CAM have indicated that their doctors are aware. The primary reason patients cite for not informing their practitioner is that the physician never asked. Studies also indicate that the great majority of patients using CAM do so in conjunction with standard cancer therapies, and not to the exclusion of oncologic treatments that are physician-endorsed.

Most oncologists are comfortable with their patients' use of CAM. Overall there is little clinical evidence to suggest that complementary therapies cause harm or interact unfavorably with regular medications. However, physicians are concerned that ingested or injected CAM might pose risks to some patients (See Table 1). Some might biochemically interfere with the effect of the chemotherapy or radiation therapy either negating or intensifying its action. In addition, although often taken to decrease the side effects and toxicity of conventional therapy, CAM may sometimes have unwarranted side effects of their own. For example, they may worsen other medical conditions a patient has such as high blood pressure. Lastly, because CAM therapies do not require FDA approval they are not subject to the same manufacturing and purity standards as regulated pharmaceuticals. This has led to production batches containing impurities (such as the case with Tryptophan causing eosinophilic myalgia syndrome) or high levels of lead in supplements given to children.

As a patient, it is always a good idea to discuss the use of CAM with your oncologist. Not only will it make them aware of other therapies you are using, but also the reasons that you may need them such as insomnia, pain, depression, anxiety, etc. Bringing along any data or literature you may have will be helpful to your doctor. As well, there are multiple Internet websites available for you to research CAM. Try looking at several, from a variety of different groups (manufacturers, support groups, medical) before starting complementary therapies. The NCCAM website is a good starting place - nccam.nih.gov.

The medical community recognizes the growing use of CAM and the need to investigate these medicines and their side effects, and much of the research is being done through the NCCAM.

Table I

Product

Alias

Toxin(s)

Side Effects

Aconite

Monkshood
Wolfbane

Aconite, Hypaconitine

Nausea, vomiting, neuromuscular weakness, seizures, coma

Cardiac effects- bradycardia, arrhythmia, and hypotension

Chaparral Tea

   

Liver Failure

Chomper

   

May be contaminated with digitalis

Compfrey

Bruisewort, Knitbone

Pyrrolizidine

Veno-occlusive disease, vomiting, hepatomegaly, hepatic necrosis

Jin Bu Huan

   

Sedative, hepatitis, bradycardia

Lobella

   

Vomiting, coma, tachycardia, respiratory distress

Ma huang

Ephedra

Ephedrine, Pseudoephedrine

Hypertension, heart attack, stroke, arrhythmias

Headaches, seizures, tremors, anxiety, hallucinations

Pennyroyal

 

Pulegone

Liver and renal failure, nausea, vomiting, abdominal pain, shock

Alterations in mental status (delirium, confusion, agitation, seizures)

Plantain Leaf

   

May be contaminated with digitalis

Yohimbe

   

Seizures, renal failure

Table 1: Some of the CAM substances associated with specific side effects or exacerbations of other medical conditions.

References

Compiled from: Barrie R. Cassileth. The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies, New York: WW Norton & Company, 1998. and Ronald B. Mack. "Something wicked this way comes"- herbs even witches should avoid. Contemporary Pediatrics 1998 15(6):49-64

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2007/althealt_freq.pdf

Saxe GA, Madlensky L, Kealey S, et al. Disclosure to Physicians of CAM Use by Breast Cancer Patients: Findings From the Women's Healthy Eating and Living Study Integr Cancer Ther 2008 7: 122-129,

 



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