Overview
Questions and Answers About Complementary and Alternative Medicine in Cancer Treatment
Changes to This Summary (11/16/2009)

Overview

• 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 ¹).
• It is important that the same scientific evaluation that is used to assess conventional approaches be used to evaluate CAM therapies (see Question 4 ²).
• The National Cancer Institute and the National Center for Complementary and Alternative Medicine are sponsoring or cosponsoring various clinical trials (research studies with people) to study CAM therapies for cancer (see Question 6 ³).
• 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 8 ⁴).

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 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).
   • Flaxseed in postmenopausal women with hot flashes with a history of cancer (NCT00956813 ⁹).
   • Reiki/energy healing in prostate cancer patients (NCT00065208 ¹⁰).
   • Yoga for fatigue in breast cancer survivors (NCT00727662 ¹¹).

   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 ¹², 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 ¹³, which can be searched by the type of treatment or disease.
   • The OCCAM Clinical Trials Web page ¹⁴, which provides links to NCI’s PDQ Clinical Trials Database.
   • The Clinical Trials.Gov Web page ¹⁵, 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 ¹⁶.

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 ¹⁷.

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? ¹⁸
     • Selecting a CAM Practitioner ¹⁹
     • Paying for CAM Treatment ²⁰
   • 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 ²¹.

   • 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 9:00 am to 4:30 pm EST. Deaf and hearing-impaired callers with TTY equipment may call 1–800–332–8615. A trained Cancer Information Specialist is available to answer your questions.

   • PDQ

     NCI’s PDQ ²², 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 ²³.

   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.cfsan.fda.gov/~dms/supplmnt.html

   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 ²⁴, 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]
   
   

Changes to This Summary (11/16/2009)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

Glossary Terms

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.

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.

A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called allopathic medicine, conventional medicine, mainstream medicine, orthodox medicine, and Western medicine.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a 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. Also called malignancy.

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.

Cancer that begins in the skin or in tissues that line or cover internal organs.

Treatment with drugs that kill cancer cells.

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.

A nutrient that the body needs in small amounts to function and stay healthy. Coenzyme Q10 helps mitochondria (small structures in the cell) make energy. It is an antioxidant that helps prevent cell damage caused by free radicals (highly reactive chemicals). Coenzyme Q10 is fat-soluble (can dissolve in fats and oils) and is found in fatty fish, beef, soybeans, peanuts, and spinach. It is being studied in the prevention and treatment of some types of cancer and heart disease and in the relief of side effects caused by some cancer treatments. Also called CoQ10, Q10, ubiquinone, and vitamin Q10.

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.

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.

In medicine, a health problem with certain characteristics or symptoms.

A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy.

The process of identifying a disease, such as cancer, from its signs and symptoms.

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.

A drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. Doxorubicin comes from the bacterium Streptomyces peucetius. It damages DNA and may kill cancer cells. It is a type of anthracycline antitumor antibiotic. Also called Adriamycin PFS, Adriamycin RDF, doxorubicin hydrochloride, hydroxydaunorubicin, and Rubex.

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.

A procedure in which pulses of weak electrical current are sent through acupuncture needles into acupuncture points in the skin. This procedure is being studied in the prevention of nausea and vomiting in patients undergoing chemotherapy.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The FDA also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called Food and Drug Administration.

The seed of the flax plant. It is a rich source of omega-3 fatty acid, fiber, and a compound called lignin. It is being studied in the prevention of prostate cancer. Also called linseed.

A type of tumor that begins in the cells that give rise to sperm or eggs. Germ cell tumors can occur almost anywhere in the body and can be either benign or malignant.

A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

In medicine, a treatment or action taken to prevent or treat disease, or improve health in other ways.

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.

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

The upper part of the throat behind the nose. An opening on each side of the nasopharynx leads into the ear.

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.

A federal agency that uses science to explore complementary and alternative medicine (CAM) practices, trains CAM researchers, and provides authoritative information about CAM to professionals and the public. NCCAM awards grants for research projects, training, and career development in CAM; sponsors conferences, educational programs, and exhibits; studies ways to use proven CAM practices along with conventional medical practice; and supports adding CAM to medical, dental, and nursing school programs. NCCAM is part of the National Institutes of Health. Also called NCCAM.

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.

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.

Cancer that arises in immature nerve cells and affects mostly infants and children.

A health professional trained to care for people who are ill or disabled.

A product that is added to the diet. A nutritional supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called dietary supplement.

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.

Having to do with children.

A health professional who teaches exercises and physical activities that help condition muscles and restore strength and movement.

Having to do with the time after menopause. Menopause (“change of life”) is the time in a woman's life when menstrual periods stop permanently.

A person who works in a specific profession. For example, a doctor or nurse is a healthcare practitioner.

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.

A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.

To become well and healthy again.

A cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

A person who has studied science, especially one who is active in a particular field of investigation.

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.

Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.

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.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.

Having to do with treating disease and helping healing take place.

Treatment.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

To eject some or all of the contents of the stomach through the mouth.

An ancient system of practices used to balance the mind and body through exercise, meditation (focusing thoughts), and control of breathing and emotions. Yoga is being studied as a way to relieve stress and treat sleep problems in cancer patients.