Questions and Answers About Complementary and Alternative Medicine in Cancer Treatment

1. 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 different 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 that is practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by health professionals who work with them, including 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.[1]

   This summary answers some frequently asked questions about the use of CAM therapies among the general public and about how CAM therapies are evaluated, and suggests sources for more information.

2. What is integrative medicine?

   NCCAM defines integrative medicine as treatment that combines conventional medicine with CAM therapies that have been reported to be safe and effective after being studied in patients. In practice, many CAM therapies used in along with conventional medicine have not yet been well tested.

3. Are complementary and alternative therapies widely used?

   Yes. Many CAM approaches are used by a large percentage of people in the general public and cancer patients.

   The 2007 National Health Interview Survey reported about 4 out of 10 adults used CAM therapy in the past 12 months, with the most commonly used treatments being natural products and deep breathing exercises.[2]

   One large survey of cancer survivors reported on the use of complementary therapies.[3] The therapies used most often were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31-84% of children with cancer, both in and outside of clinical trials.[4] CAM therapies have been used in the management of side effects caused by cancer or cancer treatment.

4. How are CAM approaches evaluated?

   It is important that CAM therapies be evaluated with the same long and careful research process used to evaluate conventional treatments. The National Cancer Institute (NCI) and the Office of Cancer Complementary and Alternative Medicine (OCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer. A listing of these trials is available at the OCCAM Clinical Trials Web page ⁵.

   Conventional cancer treatments 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 many CAM therapies. Research of CAM therapies has been slower for a number of reasons:

   • Time and funding issues.
   • Problems finding institutions and cancer researchers to work with on the studies.
   • Regulatory issues.

   Some CAM therapies have undergone careful evaluation. A small number of CAM therapies originally meant to be alternative treatments are finding a place in cancer treatment 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,[5] 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 possibly harmful.

5. What is the NCI Best Case Series Program?

   The NCI Best Case Series Program ⁶, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies 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 warrant NCI-initiated research.

6. Are NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine?

   NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for patients with 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:

   • Electroacupuncture to treat delayed chemotherapy -induced nausea and vomiting in patients diagnosed with pediatric sarcoma, neuroblastoma, nasopharyngeal carcinoma, germ cell tumors, or Hodgkin lymphoma (NCT00040911 ⁷).

   • Effect of Coenzyme Q10 on doxorubicin blood levels in women undergoing treatment of breast cancer (NCT00976131 ⁸).

   • Curcumin for reducing skin reactions caused by radiation therapy in breast cancer patients (NCT01042938 ⁹).

   • Acupuncture to prevent dry mouth and improve quality of life in head and neck cancer patients receiving radiation (NCT01266044 ¹⁰).

   • Effect of Tai Chi versus structured exercise on physical fitness and stress reduction in cancer survivors (NCT00246818 ¹¹).

   • Acupressure for persistent cancer-related fatigue (NCT01281904 ¹²).

   Patients who are interested in taking part in these or any clinical trials should talk with their doctor.

   Several 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 following:

   • The NCI’s PDQ Clinical Trials Database ¹³, which can be searched by using criteria such 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 (1–800–4–CANCER [1–800–422–6237]; TTY: 1–800–332–8615).

   • The NCCAM Clinical Trials Web page ¹⁴, which can be searched by the type of treatment or disease.

   • The OCCAM Clinical Trials Web page ¹⁵, which provides links to NCI’s PDQ Clinical Trials Database.

   • The Clinical Trials.Gov Web page ¹⁶, which can be searched by the type of medical condition or intervention.

7. 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 9 ¹⁷.

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 ¹⁸.

9. 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

   • 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 the following:
     • Are You Considering CAM? ¹⁹
     • Selecting a CAM Practitioner ²⁰
     • Paying for CAM Treatment ²¹

   • 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-on-Demand service: 1–888–644–6226

     E-mail: info@nccam.nih.gov

     Web site: http://nccam.nih.gov

   NCI

   • OCCAM

     NCI's OCCAM coordinates the activities of 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 on the NCI Web site ²².

   • NCI Cancer Information Service

     U.S. residents may call the NCI Cancer Information Service toll free at 1–800–4–CANCER (1–800–422–6237) Monday through Friday from 8:00 AM to 8:00 PM Eastern Time. A trained Cancer Information Specialist is available to answer your questions.

   • PDQ

     NCI’s PDQ ²³, 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 found on NCI's Web site ²⁴.

   U.S. Food and Drug Administration (FDA)

   The 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.

   U.S. 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.fda.gov/ForConsumers/ConsumerUpdates/ucm153239.htm

   Federal Trade Commission (FTC)

   The 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

   CRC–240

   Washington, DC 20580

   Telephone: 1–877–FTC–HELP (1–877–382–4357) (toll free)

   Callers with TTY equipment: 202–326–2502

   Web site: http://www.ftc.gov

   CAM on PubMed

   CAM on PubMed ²⁵, 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) to articles on CAM published in scientifically based, peer-reviewed journals. These citations are a subset of NLM's PubMed system, which contains more than 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.

References

1. White JD: Complementary, alternative, and unproven methods of cancer treatment. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 3147-57. 
   
   
2. Barnes PM, Bloom B, Nahin RL: Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report (12): 1-23, 2009.  [PUBMED Abstract]
   
   
3. Gansler T, Kaw C, Crammer C, et al.: A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer 113 (5): 1048-57, 2008.  [PUBMED Abstract]
   
   
4. Kelly KM: Complementary and alternative medical therapies for children with cancer. Eur J Cancer 40 (14): 2041-6, 2004.  [PUBMED Abstract]
   
   
5. NIH Consensus Conference. Acupuncture. JAMA 280 (17): 1518-24, 1998.  [PUBMED Abstract]