It was estimated that visits to CAM practitioners increased from million in to million in , exceeding visits to all U.
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- 1. Introduction!
These data back a conservative estimate of total U. It is estimated that sales of dietary supplements have more than doubled since the passage of the law. A lobbying effort is under way to provide more government protection concerning the safety and efficacy of these readily available products, many of which are contaminated or dangerous see later sections of this chapter. The food supplement industry continues to oppose these efforts. Information about CAM is readily available on the internet. It is difficult, if not impossible, for most readers to distinguish between reputable sources of information and promotions of unproven alternatives pushed by vested interests.
CAM therapies may be categorized in a variety of ways. NCCAM currently classifies CAM therapies into five categories: alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies. Currently popular therapies within each of these categories are discussed below. Many of these approaches are unproven methods promoted as alternatives to mainstream cancer treatment. Helpful complementary or adjunctive therapies are discussed in a following section. These complete systems of theory and practice were developed by ancient cultures and remain essentially intact.
A common feature across alternative medical systems is an emphasis on working with internal natural forces to achieve a harmonic state of mind and body. Although this concept has great appeal to many members of the general public, the underlying assumptions concerning human physiology and disease are outmoded and inconsistent with current scientific understanding. TCM views people as ecosystems in miniature. Any imbalance between opposing forces, such as yin-yang, heat-cold, dampness-dryness, or disruption in the circulation of Chi or Qi , meaning life energy or vital force, produces illness.
Diagnostic techniques include examination of complexion and tongue coating, detection of distinctive scents in bodily materials, and palpation of the radial pulse for its speed and tactile characteristics. This information is matched to specific patterns of signs and symptoms to provide a TCM diagnosis e. Treatment is then geared to correcting imbalances or disruptions, primarily with herbal formulas or acupuncture. Hundreds of botanical, animal, and mineral preparations were categorized in traditional Chinese pharmacopoeias starting millennia ago. Approximately biologically active compounds have been isolated from medicinal plants [ 24 ].
Among anticancer agents, camptothecin, paclitaxel, vincristine, and indirubin are developed from Camptotheca acuminata, Taxus chinensis, Catharanthus roseus, and Baphicacanthus cusia, respectively, although the original plants were not used traditionally to treat cancer. The term ayurveda comes from the Sanskrit words ayur life and veda knowledge.
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There are specific remedies for disease, and regimens to promote health, for each body type. This medical system has a strong mind-body component, stressing the need to keep consciousness in balance. It uses techniques such as yoga and meditation to do so. Ayurveda also emphasizes regular detoxification and cleansing through all bodily orifices. Homeopathy, or homeopathic medicine, originated in 18th century Germany before the advent of modern medicine. Homeopathic remedies are available over the counter without prescriptions.
If a claim were to state that a homeopathic remedy could treat a serious disease, such as cancer, by U. However, efficacy is unlikely due to the extreme dilution of active ingredients in homeopathy, which eventuates in less than one molecule of the original substance, meaning that there is nothing in the solution [ 26 ]. Systematic reviews and meta-analyses of homeopathy clinical trials show no definitive proof that homeopathic remedies are effective for any medical condition [ 27 — 29 ].
It is based on the belief that the body will repair itself and recover from illness spontaneously once a healthy internal environment is achieved. Many remedies in naturopathy, for example, mistletoe, saw palmetto, red clover, wheat grass, and flax seed oil, overlap with those in other categories of CAM; they are reviewed in their respective sections. Advocates of dietary cancer treatments typically extend mainstream assumptions about the protective effects of fruits, vegetables, fiber, and avoidance of excessive dietary fat in reducing cancer risk to the idea that foods or vitamins can cure cancer.
Current examples include the no-dairy diet, the macrobiotic diet, fruit and vegetable cures, and metabolic therapies, offered in Tijuana, Mexico clinics. One of the best known sites for this questionable practice is the Gerson Clinic, where liver damage is counteracted with a low-salt, high-potassium diet, coffee enemas, and a gallon of fruit and vegetable juice daily [ 30 ].
Its use of oral crude liver extract was associated with repeated cases of bacterial contamination [ 31 ], although the Gerson. Modern variations on the older approach to internal cleansing are drinkable cleansing formulas, said to detoxify and rejuvenate the body. These products tend to function as major laxatives, potentially dangerous when taken over days or weeks or on a regular basis as recommended by promoters, especially for cancer patients.
Neither the presence of toxins nor the benefit of eliminating them has been documented. The macrobiotic diet was developed in the s by George Ohsawa , a Japanese philosopher who sought to integrate traditional oriental medicine, Christian teachings, and aspects of Western medicine [ 32 , 33 ]. This is essentially a vegetarian diet, with emphasis on whole grains, legumes, fresh vegetables, and the occasional intake of fish. The selection of foods is so limited that people on this diet may develop significant nutritional deficiencies.
Although healthful nutrition is important for patients and has value in cancer prevention, neither this nor any other diet alone has been shown to cure cancer. Some patients and alternative practitioners believe that large dosages of vitamins or intravenous infusions of high-dose vitamin C can cure disease.
His claims that massive doses of vitamin C could cure cancer were not confirmed by clinical trials [ 34 , 35 ], but megavitamin and orthomolecular therapy, the latter adding minerals and other nutrients, remain popular. Perhaps the simplicity of this approach and the fact that patients can prescribe and obtain their own over-the-counter therapy contribute to its appeal.
However, megavitamin or orthomolecular therapy has not been proven to be an effective cancer treatment. Energy therapies are based on the theory that there are energy fields around the human body. It is believed that by changing the purported energy field by manual manipulations, such as Qigong or therapeutic touch, or the application of electromagnetic fields, disease can be eliminated.
The existence of such energy fields has not been scientifically proven. Therapeutic touch TT , despite its name, involves no direct contact. TT healers in many areas of the U. Bioelectromagnetic field therapies involve the use of pulsed, alternating or direct current and magnetic fields to treat medical conditions. Clinical trials have been conducted to test magnetic field therapies in managing pain [ 39 , 40 ], tremor [ 41 ], epilepsy [ 42 ], and migraine headaches [ 43 ]. No data support their role in any illness. Because this group of alternative treatments is invasive and biologically active, it is highly controversial.
One such therapy is antineoplastons, developed by Stanislaw Burzynski in his clinic in Houston, Texas [ 44 ]. A joint research effort by the NIH Office of Alternative Medicine and the NCI failed to accrue sufficient numbers of patients, and none of the six patients assessable for response showed tumor regression [ 45 ]. Further research at the Burzynski Institute was permitted under an Investigational New Drug permit [ 46 ]. Immuno-augmentation therapy IAT , subcutaneous injections of sera derived from the blood of healthy donors, was developed by the late Lawrence Burton and offered in his clinic in the Bahamas.
Burton claimed that IAT was particularly effective in treating mesothelioma [ 49 ]. Advocates of shark cartilage as a cancer therapy base their therapy on its putative antiangiogenic properties [ 51 ]. Neovastat, another cartilage extract, was associated with a survival benefit in renal cell carcinoma in higher versus lower doses [ 53 ]. However, that trial was not randomized. Many additional unproven methods, such as Laetrile [ 55 , 56 ], bioresonance therapy, oxygen and ozone therapies, insulin potentiation therapy, and many more [ 26 ], are promoted as literal alternatives to mainstream cancer treatment.
Their popularities wax and wane over time. Cancer patients use over-the-counter dietary supplements in addition to or instead of other cancer treatments. An important trend is the increased use of herbal products instead of other supplements in recent years [ 58 ]. Systematic, evidence-based information on popular dietary supplements used by cancer patients and herb-drug interactions in oncology is available to consumers and health care professionals [ 26 , 59 ]. The general public tends not to be aware that herbs are dilute natural drugs that contain scores of different chemicals, most of which have not been documented [ 60 ].
Their effects are not always predictable [ 61 ]. Neither the FDA nor any other agency examines herbal remedies for safety and effectiveness. Few products have been formally tested for side effects or quality control. Patients undergoing active treatment should be told to stop using herbal remedies, because some herbs cause problematic interactions with chemotherapeutic agents, sensitization of the skin to radiation therapy, dangerous blood pressure swings, and other unwanted interactions with anesthetics during surgery [ 62 ].
Herbs such as feverfew, garlic, ginger, and ginkgo have anticoagulant effects and should be avoided by patients on coumadin, heparin, aspirin, and related agents. Concerns have been raised recently even about dietary antioxidants, which may interact with radiation therapy or chemotherapeutic agents [ 63 ].
The risk of herb-drug interactions appears to be greatest for patients with kidney or liver problems [ 64 , 65 ]. Essiac, one of the most popular herbal alternative cancer medicines in North America, was developed initially by a Native healer from southwestern Canada. It was popularized in the s by a Canadian nurse, and comprises four herbs: burdock, turkey rhubarb, sorrel, and slippery elm. Evidence of anticancer activity has been limited to anecdotal reports [ 66 ]. No clinical studies support the use of essiac also sold as flor-essence.
Iscador, a derivative of mistletoe, is a popular cancer remedy in Europe, where it is said to have been in continuous use as a folk treatment since the time of the Druids. Iscador is available in many mainstream European cancer clinics. European governments have funded studies of the effectiveness of iscador against cancer. The results are mixed, with all studies suffering some methodological shortcomings [ 67 ]. None of the methodologically stronger trials showed efficacy in survival, according to another systematic review [ 68 ]. Several mushroom-derived compounds are approved for use as cancer treatments in Japan.
Trials on polysaccharide Kureha PSK , an extract of the mushroom Coriolus versicolor , showed superior survival with PSK compared with controls in both gastrectomy [ 69 , 70 ] and esophagectomy patients [ 71 ]. Two randomized trials of PSK given after curative resection for colorectal cancer showed that both disease-free and overall survival rates were significantly higher in the PSK group [ 72 , 73 ].
Results were less encouraging in breast cancer [ 74 , 75 ] and leukemia [ 76 ]. The proposed mechanism was immune modulation. A combination of eight herbs, all but two from TCM, PC-SPES PC for prostate cancer; spes is the Latin word for hope reduced prostate-specific antigen levels in men with advanced prostate cancer regardless of whether their disease was androgen dependent [ 78 — 81 ].
Improvements in quality of life also have been reported [ 82 ]. Estrogenic side effects occurred with PC-SPES, and its mechanism of action, although uncertain, may relate to its phytoestrogenic effects. PC-SPES was suspended from the market in early when undisclosed contamination with anxiolytic and antithrombotic agents was uncovered [ 83 ]. Mind-body interventions aim to utilize the reciprocal relationship between body and mind to help patients relax, reduce stress, and relieve symptoms associated with cancer and cancer treatments.
Hypnosis and relaxation techniques are often used by conventional practitioners, such as clinical psychologists. Several randomized trials have shown effects of hypnosis on both procedural and malignant pain [ 84 , 85 ] and on anxiety, depression, and mood in newly diagnosed cancer patients [ 86 — 88 ]. Trials also have generally found hypnosis and relaxation training to be beneficial against chemotherapy-induced nausea in adults [ 89 , 90 ], although some studies found no differences between groups [ 91 ]. Music therapy is provided by professional musicians who are also trained music therapists.
Typically they hold graduate degrees in music therapy and are trained to deal with the psychosocial as well as clinical issues faced by patients and family members. Music therapy is particularly effective in the palliative care setting, with randomized trials indicating benefit for reducing anxiety [ 92 — 96 ], depression [ 97 — 99 ], and pain [ , ]. The benefits of massage therapy are documented, especially for seriously ill and palliative care patients. Several randomized trials suggest that massage reduces anxiety, at least in the short-term, in groups as varied as adolescent psychiatric patients [ ] and elderly people in care homes [ ].
In a high-quality, if underpowered, trial, 35 patients were randomized to receive either up to nine minute massages during inpatient stays or standard care control. Massage was superior to the control treatment in reducing anxiety, nausea, and fatigue and improving general well-being [ ]. In the largest study to date, 87 hospitalized cancer patients were randomized to receive either foot massage or a control treatment.
Pain and anxiety scores were lower with massage, with differences between groups achieving both statistical and clinical significance [ ]. Modern versions include electrical pulses electro-acupuncture or laser laser acupuncture to provide extra stimulation [ ]. Stimulation is thought to regulate the flow of Qi. The biological basis of Qi or of meridian channels has not been found, but modern research suggests that the effect of acupuncture may be mediated by the release of neurotransmitters [ — ].
Data from clinical trials support the use of acupuncture for emesis [ — ] and pain [ — ]. The NIH issued a concensus statement in supporting the efficacy of acupuncture for adult postoperative and chemotherapy-associated nausea and vomiting, and for postoperative dental pain [ ]. Many cancer patients use complementary and alternative therapies [ 9 , — ]. Patients appear increasingly willing to discuss the use of these remedies, especially when asked by their oncologists. In order to encourage open communication of CAM use by their patients, oncologists should be knowledgeable about the most commonly used remedies, or at least be able to direct patients to reliable sources of information.
A few helpful web sites are listed in the reference section [ 26 , — ]. Patients should be advised to avoid questionable alternative therapies in a receptive, evidence-based atmosphere. Many unproven alternatives are promoted in a very appealing and convincing fashion. In some cases, patients feel that problems they perceive as important fail to receive sufficient attention. User Name Password Sign In. Cassileth, Ph. Accepted October 28, L earning O bjectives After completing this course, the reader will be able to: Describe the differences between complementary and alternative therapies.
List common complementary and alternative therapies used by cancer patients. Know where to access reliable information. Previous Section Next Section. CAM Practitioners Major categories of CAM practitioners outside of mainstream medicine include chiropractors, naturopaths, and acupuncturists. Traditional Medical Systems These complete systems of theory and practice were developed by ancient cultures and remain essentially intact. Ayurveda The term ayurveda comes from the Sanskrit words ayur life and veda knowledge.
Homeopathy Homeopathy, or homeopathic medicine, originated in 18th century Germany before the advent of modern medicine. Energy Therapies Energy therapies are based on the theory that there are energy fields around the human body. Biologic Treatments Because this group of alternative treatments is invasive and biologically active, it is highly controversial.
Dietary Supplements and Herbal Remedies Cancer patients use over-the-counter dietary supplements in addition to or instead of other cancer treatments. Helpful Complementary Therapies Mind-body interventions aim to utilize the reciprocal relationship between body and mind to help patients relax, reduce stress, and relieve symptoms associated with cancer and cancer treatments. Previous Section. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med ; : — CrossRef Medline Google Scholar.
The profile of women who consult alternative health practitioners in Australia. Med J Aust ; : — Medline Google Scholar. NZ Med J ; : U Complementary and alternative medicine use among men with prostate cancer in 4 ethnic populations. Am J Public Health ; 92 : — Trends in alternative medicine use in the United States, — results of a follow-up national survey. JAMA ; : — Complementary and alternative medicines in cancer therapy. Publication BFHC Google Scholar. Ernst E, Cassileth BR. Cancer ; 83 : — Utilization of complementary and alternative medicine by United States adults: results from the national health interview survey.
Med Care ; 40 : — Use of alternative medicine by women with early-stage breast cancer. N Engl J Med ; : — Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst ; 94 : 39 — Unconventional therapies for cancer and cancer-related symptoms. Lancet Oncol ; 2 : — Roles of nonphysician clinicians as autonomous providers of patient care. Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians.
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Add-On Complementary Medicine in Cancer Care: Evidence in Literature and Experiences of Integration
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Efficacy of static magnetic field therapy in chronic pelvic pain: a double-blind pilot study. Am J Obstet Gynecol ; : — Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: a double-blind clinical trial. Skickas inom vardagar. Complementary methods are playing an increasingly important role in these treatment of cancer. Resulting benefits are a higher quality of life, reduced instance and severity of the side effects of standard therapy, and a general improvement of the patient's immunological state.
The methods - from carefully monitored nutrition, exercise, and psychological support to enzyme substitution, phytotherapy, hyperthermia and microbiology therapy - are critical to a treatments overall success. In this unique book, experts ranging across medical disciplines present scientifically proven data on the efficacy of these methods as they are currently being used, the necessary scientific background, and practical advice for introducing them into practice.
With illustrations, tables, and detailed descriptions, this book is an ideal reference and an invaluable tool for educating patients about this encouraging aspect of cancer therapy. Passar bra ihop.