MsC1210 Posted November 12, 2008 Share Posted November 12, 2008 Complementary and Alternative Medicine in Cancer Treatment: Questions and Answers 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 (see Question 1). It is important that the same scientific evaluation that is used to assess conventional approaches be used to evaluate CAM therapies (see Question 3). The National Cancer Institute and the National Center for Complementary and Alternative Medicine are sponsoring or cosponsoring various clinical trials (research studies) to study CAM therapies for cancer (see Question 5). It is important that patients inform all of their health care providers about any therapies they are currently using or considering. This is to help ensure a safe and coordinated course of care (see Question 7). What is complementary and alternative medicine? Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place 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. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM. This fact sheet answers some frequently asked questions about the use of CAM therapies among the general public, and about how CAM approaches are evaluated, and suggests sources for further information. Are complementary and alternative therapies widely used? The results of studies of CAM use have been inconsistent. One large-scale study published in the November 11, 1998, issue of the Journal of the American Medical Association found that CAM use among the general public increased from 33.8 percent in 1990 to 42.1 percent in 1997. However, an analysis of data from the 1999 National Health Interview Survey indicated that only 28.9 percent of U.S. adults (age 18 and over) had used at least one CAM therapy in the past year. These results were published in the journal Medical Care in 2002. Several surveys of CAM use by cancer patients have been conducted with small numbers of patients. One study published in the February 2000 issue of the journal Cancer reported that 37 percent of 46 patients with prostate cancer used one or more CAM therapies as part of their cancer treatment. These therapies included herbal remedies, vitamins, and special diets. A larger study of CAM use in patients with different types of cancer was published in the July 2000 issue of the Journal of Clinical Oncology. This study found that 69 percent of 453 cancer patients had used at least one CAM therapy as part of their cancer treatment. 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? It is important that the same rigorous scientific evaluation used to assess conventional approaches be used to evaluate CAM therapies. The National Cancer Institute (NCI) and NCCAM are funding a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer. Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Some CAM therapies have undergone rigorous evaluation. A small number of CAM therapies 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. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of 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. What is the Best Case Series Program? The Best Case Series Program, which was started by the NCI in 1991, is one way CAM approaches that are being used in practice are being evaluated. The program is overseen by the NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer CAM services submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches that have therapeutic potential. Are the NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine? The NCI and NCCAM are currently sponsoring or cosponsoring various 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. Current trials include the following: Acupuncture to reduce the symptoms of advanced colorectal cancer Combination chemotherapy plus radiation therapy with or without shark cartilage in the treatment of patients who have non-small cell lung cancer that cannot be removed by surgery Hyperbaric oxygen therapy with laryngectomy patients (people who have had an operation to remove all or part of the larynx (voice box)) Massage therapy for cancer-related fatigue Chemotherapy compared with pancreatic enzyme therapy plus specialized diet for the treatment of pancreatic cancer Mistletoe extract and chemotherapy for the treatment of solid tumors Patients who are interested in taking part in these or any clinical trials should talk with their doctor. The NCI, NCCAM, and OCCAM clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching: The NCI’s PDQ® Clinical Trials Database—The PDQ Clinical Trials database can be searched at http://www.cancer.gov/clinicaltrials/search using such criteria as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI’s Cancer Information Service (see below). The NCCAM Clinical Trials Web page—Clinical trials can be searched by type of treatment or disease at http://nccam.nih.gov/clinicaltrials/ on the Internet. The OCCAM Clinical Trials Web page—Links are provided to the NCI’s clinical trials databases at http://www.cancer.gov/cam/clinicaltrials_intro.html on the Internet. What should patients do when using or considering complementary and alternative therapies? Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. Some resources for this information are provided in Question 8. When considering complementary and alternative therapies, 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 side effects can be expected? 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? Further information on evaluating CAM therapies and practitioners is available from NCCAM (see below). What Federal agencies can provide more information about CAM therapies? Patients, their families, and their health care providers can learn about CAM therapies from the following Government agencies and resources: NCCAM is the Federal Government’s lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. The NCCAM Clearinghouse provides information on NCCAM and on CAM, including fact sheets, other publications, and searches of Federal databases of scientific and medical literature. Publications include: “Are You Considering Using Complementary and Alternative Medicine (CAM)?” (http://nccam.nih.gov/health/decisions) “Selecting a Complementary and Alternative Medicine Practitioner” (http://nccam.nih.gov/health/practitioner) “Consumer Financial Issues in Complementary and Alternative Medicine” (http://nccam.nih.gov/health/financial/index.htm) The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. NCCAM Clearinghouse Post Office Box 7923 Gaithersburg, MD 20898–7923 Toll-free in the United States: 1–888–644–6226 International: 301–519–3153 Callers with TTY equipment: 1–866–464–3615 Fax: 1–866–464–3616 Fax-on-Demand service: 1–888–644–6226 E-mail: info@nccam.nih.gov Web site: http://nccam.nih.gov The NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine. OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via http://www.cancer.gov/cam on the Internet. NCI’s PDQ, a comprehensive cancer information database, contains peer-reviewed summaries of the latest information about the use of CAM in the treatment of cancer. Each summary contains background information about the specific treatment, a brief history of its development, information about relevant research studies, and a glossary of scientific and medical terms. CAM summaries can be accessed at http://www.cancer.gov/cancerinfo/pdq/cam on the Internet. The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective. This agency provides a number of publications for consumers, including information about dietary supplements. Food and Drug Administration 5600 Fishers Lane Rockville, MD 20857 Telephone: 1–888–463–6332 (toll-free) Web site: http://www.fda.gov/ FDA’s Dietary Supplements Web page: http://www.cfsan.fda.gov/~dms/supplmnt.html The Federal Trade Commission (FTC) enforces consumer protection laws and offers publications to guide consumers. The FTC also collects information about fraudulent claims. Consumer Response Center Federal Trade Commission 600 Pennsylvania Avenue, NW. H–130 Washington, DC 20580 Telephone: 1–877–382–4357 (1–877–FTC–HELP ) (toll-free) Callers with TTY equipment: 202–326–2502 Web site: http://www.ftc.gov/ CAM on PubMed®, a database accessible via the Internet, was developed jointly by NCCAM and the NIH National Library of Medicine (NLM). It contains bibliographic citations (from 1966 to the present) for articles in scientifically based, peer-reviewed journals on CAM. These citations are a subset of the NLM’s PubMed system, which contains over 11 million journal citations from the MEDLINE® database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to many publisher Web sites, which may offer the full text of articles. To access CAM on PubMed, go to http://nccam.nih.gov/camonpubmed/ on the Internet. MedlinePlus®, a tool provided by the NLM, is a searchable database of health information. The Drug, Supplements, and Herbal Information section has extensive information about dietary and herbal supplements, as well as drugs. This resource is available at http://www.nlm.nih.gov/medlineplus/druginformation.html on the Internet. References Bennett M, Lengacher C. Use of complementary therapies in a rural cancer population. Oncology Nursing Forum 1999; 26(:1287–1294. Cassileth BR, Chapman CC. Alternative and complementary cancer therapies. Cancer 1996; 77(6):1026–1034. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997. Results of a follow-up national survey. Journal of the American Medical Association 1998; 280(18):1569–1575. Kao GD, Devine P. Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy. Cancer 2000; 88(3):615–619. Nelson W. Alternative cancer treatments. Highlights in Oncology Practice 1998; 15(4):85–93. Ni H, Simile C, Hardy AM. Utilization of complementary and alternative medicine by United States adults: Results from the 1999 national health interview survey. Medical Care 2002; 40(4):353–358. Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE. 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, Bauer L, Curt G, et al. Use of complementary medicine by adult patients participating in cancer clinical trials. Oncology Nursing Forum 2000; 27(4):623–630. White JD. Complementary, alternative, and unproven methods of cancer treatment. In: DeVita VT Jr., Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. Vol. 1 and 2. 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2001. # # # Related Resources Publications (available at http://www.cancer.gov/publications) Thinking About Complementary and Alternative Medicine—A Guide for People With Cancer 1 National Cancer Institute (NCI) Resources Cancer Information Service (toll-free) Telephone: 1–800–4–CANCER (1–800–422–6237) TTY: 1–800–332–8615 Online NCI’s Web site: http://www.cancer.gov LiveHelp, NCI’s live online assistance: https://cissecure.nci.nih.gov/livehelp/welcome.asp Glossary Terms acupuncture (AK-yoo-PUNK-cher) The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine. alternative medicine (all-TER-nuh-tiv MEH-dih-sin) Practices used instead of standard treatments. They generally are not recognized by the medical community as standard or conventional medical approaches. Examples of alternative medicine include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. CAM Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called complementary and alternative medicine. cancer (KAN-ser) A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Cancer Information Service The Cancer Information Service is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER (1-800-422-6237), or by using the LiveHelp instant-messaging service at https://cissecure.nci.nih.gov/livehelp/welcome.asp. Also called CIS. cartilage (KAR-tih-lij) A tough, flexible tissue that lines joints and gives structure to the nose, ears, larynx, and other parts of the body. case series A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. chemotherapy (KEE-moh-THAYR-uh-pee) Treatment with drugs that kill cancer cells. clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study. colorectal cancer (KOH-loh-REK-tul KAN-ser) Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus). combination chemotherapy (KOM-bih-NAY-shun KEE-moh-THAYR-uh-pee) Treatment using more than one anticancer drug. complementary and alternative medicine (KOM-pleh-MEN- tuh-ree... all-TER-nuh-tiv MEH-dih-sin) Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called CAM. complementary medicine (KOM-pleh-MEN-tuh-ree MEH-dih-sin) Practices often used to enhance or complement standard treatments. They generally are not recognized by the medical community as standard or conventional medical approaches. Complementary medicine may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. conventional treatment A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. dietary supplement (DY-uh-TAYR-ee SUH-pleh-ment) A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement. drug Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic. fatigue A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic. hyperbaric oxygen (HY-per-BAYR-ik OK-sih-jen) Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. laetrile (LAY-eh-tril) A substance found in the pits of many fruits such as apricots and papayas, and in other foods. It has been tried in some countries as a treatment for cancer, but it has not been shown to work in clinical studies. Laetrile is not approved for use in the United States. Also called amygdalin. laryngectomy (LA-rin-JEK-toh-mee) An operation to remove all or part of the larynx (voice box). larynx (LAYR-inks) The area of the throat containing the vocal cords and used for breathing, swallowing, and talking. Also called voice box. mistletoe A semiparasitic plant that grows on some types of trees. Mistletoe extracts are being studied as treatments for cancer. National Cancer Institute The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI. National Institutes of Health A federal agency in the U.S. that conducts biomedical research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information. Access the National Institutes of Health Web site at http://www.nih.gov. Also called NIH. nausea A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy. non-small cell lung cancer A group of lung cancers that are named for the kinds of cells found in the cancer and how the cells look under a microscope. The three main types of non-small cell lung cancer are squamous cell carcinoma, large cell carcinoma, and adenocarcinoma. Non-small cell lung cancer is the most common kind of lung cancer. nurse A health professional trained to care for people who are ill or disabled. pancreatic cancer (pan-kree-AT-ic KAN-ser) A disease in which malignant (cancer) cells are found in the tissues of the pancreas. Also called exocrine cancer. pancreatic enzyme A protein secreted by the pancreas that aids in the digestion of food. PDQ PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query. physical therapist A health professional who teaches exercises and physical activities that help condition muscles and restore strength and movement. prostate cancer (PROS-tayt KAN-ser) Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men. psychologist (sy-KAH-loh-jist) A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions. radiation therapy (RAY-dee-AY-shun THAYR-uh-pee) The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy. side effect A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores. solid tumor An abnormal mass of tissue that usually does not contain cysts or liquid areas. Solid tumors may be benign (not cancerous), or malignant (cancerous). Different types of solid tumors are named for the type of cells that form them. Examples of solid tumors are sarcomas, carcinomas, and lymphomas. Leukemias (cancers of the blood) generally do not form solid tumors. standard therapy (...THAYR-uh-pee) In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called best practice and standard of care. surgery (SER-juh-ree) A procedure to remove or repair a part of the body or to find out whether disease is present. An operation. symptom An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain. therapeutic (THAYR-uh-PYOO-tik) Having to do with treating disease and helping healing take place. vitamin A key nutrient that the body needs in small amounts to grow and stay strong. Examples are vitamins A, C, and E. vomit To eject some or all of the contents of the stomach through the mouth. 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