This article is more than 5 years old. Information may no longer be current.
Know your patients’ use of complementary and alternative medicine in oncology
In this Ask the Experts feature, David Rosenthal, MD, of Harvard Medical School, discusses the wide range of CAM therapies and their clinical relevance in oncology.
Click Here to Manage Email Alerts
What are the major complementary and alternative medicine (CAM) therapies that have proliferated in the past decade?
Of the major CAM therapies, mind-body practices and biologically based systems appear to be the most commonly used. Mind-body therapies include meditation, biofeedback, practicing the relaxation response, prayer and other interventions such as music and expressive arts therapy. These therapies have been used to decrease the stress and anxiety of dealing with cancer, as well as attempting to alleviate the cancer and treatment-related symptoms. Biologically based practices are the most common among CAM practices and the most expensive. These practices include dietary supplements, biologic and herbal products, including vitamins, American and Chinese herbs, special diets and antioxidants. The use of vitamins and antioxidants increases dramatically after someone is diagnosed with cancer or a hematological malignancy. In addition, the emergence of research data is expanding the landscape of the clinical use of acupuncture in hematology/oncology for symptom management.
Which CAM therapies have clinical efficacy data to back them up?
As we look at all five of the domains of CAM — that is, mind-body medicine, biologically based practices, manipulative and body-based practices, energy medicine, and whole medical systems — the most studied is mind-body medicine and traditional Chinese medicinal use of acupuncture. There is increasing evidence that the mind-body programs, specifically inducing the relaxation response, can reduce stress and anxiety and alleviate common symptoms of fatigue and pain in cancer patients. Acupuncture is being extensively studied for symptom management in cancer with randomized clinical trials. In these studies, acupuncture has been shown to be beneficial for chemotherapy-induced nausea and vomiting, cancer-related pain, radiation-induced xerostomia and aromatase inhibitor arthralgias in breast cancer. There is also an increasing number of pilot studies showing improvement in the overall quality of life of cancer patients while receiving regular acupuncture treatments.
|
|
What are the dangers of unregulated use of CAM therapies?
One of the most utilized practices of CAM, the biologically based use of dietary supplements and herbal products, is probably the least evidence-based and the most concerning to practicing clinicians. Although it is helpful to have a phytonutrient rich diet (plant-based), many patients increase their over-the-counter supplements and herbal products to boost their immune systems and increase their blood antioxidant levels.
However, there can be significant complications with some herbal products. There can be direct toxic events, such as cyanide effects of laetrile or hepatorenal failure with hydrazine sulfate. Drug-herb and drug-drug and radiation-antioxidant interactions can be extremely harmful. For example, certain herbs, like St. John’s wort, can stimulate the cytochrome P450 system in the liver and rapidly clear effective chemotherapeutic agents from the plasma. Alternatively, there are some herbs that inhibit the enzyme system and may cause higher than expected levels of some of the chemotherapeutic agents. The use of OTC antioxidants alongside chemotherapy and radiation therapy is still under investigation, and studies continue to evaluate the pros and cons of antioxidants while receiving cancer therapy.
What advice should physicians give to patients seeking information on CAM therapies?
First and foremost, physicians should ask their patients about their CAM use. Physicians should then guide patients about the advantages and limitations of CAM therapy in an open, evidence-based and patient-centered manner. If it is safe and effective, you may recommend or agree with the use. If it is toxic and ineffective, strongly advise against its use. If it is safe but has no known beneficial effect, then you can approve its use but recommend that the patient closely monitor any effects, both beneficial and adverse. It is important to evaluate whether there is any known adverse interaction with any current medications the patient may be taking. There are a number of available databases that can assist the physician in learning the side effects of herbs and botanicals and their adverse interactions with known medications.
For more information:
- Deng GE. J Soc Integr Oncol. 2007;5:65-84.