Cancer and CAM
Key Points
- Complementary and alternative medicine (CAM) is a group of
diverse medical and health care systems, practices, and
products that are not presently considered to be part of
conventional medicine. Medicine as practiced by holders of
M.D. (medical doctor) or D.O. (doctor of osteopathy)
degrees and by their allied health professionals such as
physical therapists, psychologists, and registered
nurses..
- The same scientific evaluation that is used to assess
conventional cancer treatments should be used to assess CAM
therapies.
- The National Center for Complementary and Alternative
Medicine (NCCAM) is sponsoring a number of clinical trials
(research studies in people) to study CAM therapies for
cancer.
- Tell your health care providers about any complementary
and alternative practices you use. Give them a full picture
of what you do to manage your health. This will help ensure
coordinated and safe care.
What is complementary and
alternative medicine?
Complementary and alternative medicine is a group of diverse
medical and health care systems, practices, and products that
are not presently considered to be part of conventional
medicine. Conventional medicine is medicine as practiced by
holders of M.D. (medical doctor) or D.O. (doctor of osteopathy)
degrees and by their allied health professionals, such as
physical therapists, psychologists, and registered nurses. Some
health care providers practice both CAM and conventional
medicine.
- Complementary medicine is used together with
conventional medicine.
- Alternative medicine is used in place of conventional
medicine.
- Integrative medicine combines treatments from
conventional medicine and CAM for which there is some
high-quality evidence of safety and effectiveness. It is
also called integrated medicine. An approach to medicine
that combines treatments from conventional medicine and CAM
for which there is some high-quality scientific evidence of
safety and effectiveness..
This fact sheet answers some frequently asked questions
about the use of CAM therapies and the way that CAM approaches
are evaluated. To find out more about topics and resources
mentioned in this fact sheet, see "For
More Information."
Is CAM widely
used?
According to a comprehensive survey on Americans' use of
CAM, 36 percent of U.S. adults are using some form of CAM. When
megavitamin therapy and prayer for health reasons are included
in the definition of CAM, that percentage rises to 62 percent.
These results are based on the 2002 National Health Interview
Survey, which was supported by NCCAM and the National Center
for Health Statistics (part of the Centers for Disease Control
and Prevention). The survey found that rates of CAM use are
especially high among patients with serious illnesses such as
cancer.
Several smaller studies of CAM use by cancer patients have been
conducted. A study of CAM use in patients with cancer in the
July 2000 issue of the Journal of Clinical Oncology found that
69 percent of 453 cancer patients had used at least one CAM
therapy as part of their cancer treatment. A study published in
the December 2004 issue of the Journal of Clinical Oncology
reported that 88 percent of 102 people with cancer who were
enrolled in phase I clinical trials (research studies in
people) at the Mayo Comprehensive Cancer Center had used at
least one CAM therapy. Of those, 93 percent had used
supplements (such as vitamins or minerals), 53 percent had used
nonsupplement forms of CAM (such as prayer/spiritual practices
or chiropractic care), and almost 47 percent had used both.
A review article in the March 2005 issue of the Southern
Medical Journal reported that cancer patients take supplements
to reduce side effects and organ toxicity, to protect and
stimulate their immune systems, or to prevent further cancers
or recurrences. Patients frequently see using supplements as a
way to take control over their health and increase their
quality of life.
Additional information about CAM use among cancer patients can
be found in a review article published in Seminars in Oncology
in December 2002.
How are CAM approaches
evaluated?
The same rigorous scientific evaluation used to assess
conventional cancer treatments should be used for CAM
therapies. NCCAM is funding a number of clinical trials to
evaluate CAM therapies for cancer.
Conventional cancer treatments are studied for safety and
effectiveness through a rigorous scientific process that
includes laboratory research and clinical trials with large
numbers of patients. Less is known about the safety and
effectiveness of complementary and alternative methods to treat
cancer, although some CAM therapies have undergone rigorous
evaluation.
A small number of CAM
therapies, which were originally considered to be
purely alternative approaches, are finding a place in cancer
treatment—not as cures, but as complementary therapies that may
help patients feel better and recover faster. One example is
acupuncture,
a family of procedures that originated in traditional
Chinese medicine. Acupuncture is the stimulation
of specific points on the body by a variety of techniques,
including the insertion of thin metal needles though the skin.
It is intended to remove blockages in the flow of qi and
restore and maintain health.. In 1997, a panel of experts at
the National Institutes of Health (NIH) Consensus Conference
found acupuncture to be effective in managing
chemotherapy-associated nausea and vomiting and in controlling
pain associated with surgery. In contrast, some approaches,
such as the use of laetrile, have been studied and found
ineffective or potentially harmful.
Is NCCAM sponsoring clinical
trials on CAM for cancer?
NCCAM is sponsoring a number of clinical trials to study
complementary and alternative treatments for cancer. Some of
these trials study the effects of complementary approaches used
in addition to conventional treatments, while others compare
alternative therapies with conventional treatments. Recent
trials include the following:
- Acupuncture to relieve neck and shoulder pain following
surgery for head or neck cancer
- Ginger as a treatment for nausea and vomiting caused by
chemotherapy
- Massage
for the treatment of cancer pain
- Mistletoe extract combined with chemotherapy for the
treatment of solid tumors
Patients who are interested in taking part in these or any
other clinical trials should talk with their health care
provider.
Patients, family members, and health professionals can use the
following Web resources to find out about CAM clinical
trials:
- The NCCAM
Clinical Trials Web page. Describes current clinical
trials for cancer and other health conditions.
Information on clinical trials is also available through
the NCCAM Clearinghouse.
- The National Cancer Institute (NCI) PDQ Clinical
Trials Database. Includes studies of CAM and
conventional medicine for cancer. This information is
also available through NCI's Cancer Information
Service.
What should patients do when
using or considering CAM therapies?
Cancer patients who are using or considering CAM should discuss
this decision with their health care provider, as they would
any therapy. Some complementary and alternative therapies may
interfere with standard treatment or may be harmful when used
along with standard treatment. The
booklet (pdf file) "Thinking About Complementary and
Alternative Medicine: A Guide for People with Cancer"
discusses choices that people face in making decisions about
cancer treatment and includes suggestions on how to talk
with health care providers about these choices.
As with any medicine or treatment, it is a good idea to learn
about the therapy, including whether the results of scientific
studies support the claims that are made for it.
When considering CAM, what
questions should patients ask their health care
providers?
- What benefits can be expected from this therapy?
- What are the risks associated with this therapy?
- Do the known benefits outweigh the risks?
- What are the potential side effects?
- Will the therapy interfere with conventional
treatment?
- Is this therapy part of a clinical trial? If so, who is
sponsoring the trial?
- Will the therapy be covered by health insurance?
These fact sheets contain further information on evaluating
CAM therapies, selecting practitioners, and considering
financial issues for CAM treatment:
References
- Barnes PM, Powell-Griner E, McFann K,
Nahin RL.
Complementary
and alternative medicine use among adults: United States,
2002. CDC Advance Data
Report #343. 2004.
- Dy GK, Bekele L, Hanson LJ, et
al.
Complementary
and alternative medicine use by patients enrolled onto
phase I clinical trials.
Journal of Clinical
Oncology.
2004;22(23):4810–4815.
- Frenkel M, Ben-Arye E, Baldwin C,
et al.
Approach to
communicating with patients about the use of nutritional
supplements in cancer
care. Southern Medical
Journal.
2005;98(3):289–294.
- National Cancer
Institute.
PDQ Cancer
Information Summary:
Laetrile/Amygdalin. National Cancer
Institute Web site. Accessed on
August 11, 2005.
- National Institutes of
Health.
Acupuncture: NIH Consensus
Statement. National
Institutes of Health Office of Disease Prevention Web
site. Accessed on August 30, 2005.
- Richardson MA, Sanders T, Palmer
JL, et al.
Complementary/alternative medicine use in
a comprehensive cancer center and the implications for
oncology. Journal of Clinical
Oncology. 2000;18(13):2505–2514.
- Richardson MA, Straus SE.
Complementary
and alternative medicine: opportunities and challenges for
cancer management and
research. Seminars in
Oncology.
2002;29(6):531–545.
- Sparber A, Wooton JC.
Surveys of
complementary and alternative medicine: Part II. Use of
alternative and complementary cancer
therapies.
Journal of
Alternative and Complementary
Medicine.
2001;7(3):281–287.
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