Complementary and Alternative Medicine and its use in Cancer Patients

Complementary and alternative medicine (CAM) is defined as a group of different medical and health care practices with non-pharmacological products that are not presently considered part of conventional medicine. Complementary medicine is used together or in a small group of patients in place of conventional medicine practised by holders of medical a doctor degree. The United State 2007 National Health Interview Survey reported about 4 out of 10 adults used CAM therapy. In one, large survey of cancer survivors using complementary therapies., it was reported that the most used CAMs were prayer/spiritual practice (61.4%), relaxation (44.3%), faith/spiritual healing (42.4%), nutritional supplements/vitamins (40.1%), meditation (15%), religious counseling (11.3%), massage (11.2%), and support groups (9.7%), acupuncture/acupressure (1.2%). biofeedback therapy (1.0%) and hypnosis (0.4%). Survivors more likely to use CAMs were female, younger, white, on a higher income, and more educated. In another large study with around 2000 cancer patients performed in the USA it was found that 75% of cancer patients reported using CAMs. Breast cancer patients were far more likely to be consistent users compared with other tumor types.  

The US NCCAM (National Center for Complementary and Alternative medicine) is a federal government agency which leads the scientific research on CAMs. The NCCAN together with the NCI (National Cancer Institute), are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for cancer patients. Some of these trials are studying the effects of complementary approaches used in addition to conventional treatment, while others are comparing alternative therapies with conventional treatments. As an example of current trials we have the effect of Coenzyme Q10 on doxorubicin blood levels in breast cancer patients, the effect of vitamin D and soy extract on lowering PSA in recurrent prostate cancer patients, acupuncture to prevent dry mouth in head and neck cancer patients receiving radiation, the effect of Tai Chi versus structured exercise on physical fitness and stress reduction in cancer survivors among others. There are many opponents of the NCCAM because of its support of projects perceived as irrational and unscientific. However, the NCCAM has also supported critical research that has demonstrated the ability of CAMs to control many physical and emotional symptoms, including those that are not well managed by the traditional standard of care.

The available scientific evidence does not support claims that CAM, when used without mainstream or conventional medicine, is effective in treating cancer or any other disease. Many health professionals promote healthy lifestyle habits such as exercising, eating a nutritious diet, not smoking, and managing stress (by music and art therapy, massage therapy, mind-body therapies etc) as important in maintaining good health as to adjunctive interventions intended to reduce the physical and emotional symptoms associated with cancer and its treatment. Health professionals realize that a person's health depends on the balance of physical, psychological, social, and cultural forces. Many cancer centers have integrative oncology programs in which complementary treatment is offered and often subjected to study.

Recently, a publication has been published states that some breast patients opt for alternative treatments in place of conventional treatments. This approach is very disappointing for oncologists as it has been demonstrated that CAMs used as primary treatment for breast cancer are associated with increased recurrence and death. In this regard, it is important to know why CAMs were selected by these patients. In the breast cancer literature the following reasons have been found for selecting CAMs: need for control, fear of adverse events, and poor communication with physicians. These findings suggest that there are modifiable factors for choosing CAMs which may be addressed with better communication and with educational initiatives for patients. In this respect, patients, the general population, and health professional have a pending task in order to improve communication and education about the pro and cons of conventional medicine and CAMs. Thus, we may expect that cancer patients who have rejected the use of conventional therapies will begin to think differently and consider conventional medicine as the only option to extend survival and increase the options of a cure.  

Author: Dr. Luis Mendoza