Complementary and Alternative Therapies for Cancer Patients

Many patients are finding that CAM therapies have a great deal to offer, and an increasing amount of information is available to help you make personal, informed choices about integrating these therapies with Western medicine.  Additionally, greater numbers of licensed physicians and other credentialed health care practitioners are offering complementary and alternative therapies as part of their services.  The number of complimentary and alternative therapies now available as well as the different types of practitioners can, however, be overwhelming.  We hope to lessen the confusion by providing you with the “tools” you need to feel you can reasonably and wisely make informed choices.  In this section we will discuss the difficulties associated with evaluating CAM therapies, the barriers related to researching these therapies and the questions and information you will need to evaluate the different therapies and practitioners so as to avoid being misinformed.

B.  Difficulties Evaluating Complementary and Alternative Therapies

Complementary and alternative medicine can, in some instances, be evaluated with the same methods used in conventional medicine.  However, many of the CAM therapies cannot be scientifically evaluated because the effects of treatment are more subjective, based on how a patient feels, both physically and emotionally.  Subjective responses include improved energy, appetite and well-being.  Scientific medicine has just begun the difficult task of trying to evaluate these kinds of "quality of life" responses.  It is reasonable to assume that more sophisticated evaluations of these responses will be developed in time, but currently few scientific studies of CAM therapies have been conducted. 

To gain acceptance by the medical “mainstream,” scientific evaluation is important in understanding if, when and how complementary and alternative therapies work.  In 1992 by congressional mandate, the National Institutes of Health (NIH) established the Office of Alternative Medicine (OAM).  In 1998, the OAM expanded into the National Center for Complementary and Alternative Medicine (NCCAM.  The purpose of this office, as outlined in the Senate Bill, is "to facilitate the evaluation of alternative medical treatment modalities."  The NCCAM is funding several medical centers to evaluate complementary and alternative therapies by developing scientific studies to test them. 

Often, less is known about the safety and effectiveness of complementary and alternative medicine compared to conventional medical approaches because few CAM therapies have undergone rigorous scientific evaluation.  However, some have found a role in cancer treatment, not as cures, but as complementary therapies that may help patients feel better and recover faster.  Dr. Michael Lerner, author of Choices in Healing and president of Commonweal, a health and environmental research institute, believes caution is the best approach when using alternative therapies.  It is his opinion that the best CAM treatments tend to be those that increase quality of life, promote general health and engage the patient in psychologically and physically beneficial ways.  The worst treatments are those offered by unscrupulous people for financial gain.  Between these two extremes are many therapies with both positive and negative effects.

C.  Barriers to Complementary and Alternative Medicine-Related Research

According to the American Cancer Society, acceptable therapies are ones which have been subjected to extensive laboratory (in vitro) and subject (in vivo) testing in both animals and humans and whose results have been published in peer-reviewed journals.  Unfortunately this limited definition excludes many important factors believed to be benefits of CAM therapies.  While clinical trials can and do provide the medical community with important information on the effects of new treatments, the lack of scientific proof alone is perhaps not reason enough to dismiss the possibility that a new treatment might be valuable or effective.

The lack of scientific data may partly be the result of the medical community's past skepticism of the possible validity of a treatment with which it is unfamiliar.  For instance, some alternative clinicians cannot present research data because they have difficulty finding an interested publisher.  However, even after having published in peer-reviewed literature, controversial ideas have a difficult time gaining acceptance from the “mainstream” medical community.  The lack of scientific evidence may also be due to the small numbers of physicians and scientific researchers willing to take the huge professional risk to his/her career and/or reputation to pursue research in CAM therapies.  While this situation is gradually changing because of increased public interest in CAM therapies, clinical trials are time intensive and costly.  Because many CAM therapies cannot be patented, there is little financial incentive for pharmaceutical companies to fund research.  As a result, anecdotal evidence remains the major source of information. 

Other factors make data difficult to gather.  For example, many alternative medical clinics are in Mexico and Europe.  Collecting follow-up data can be difficult to impossible.  For example, patients may complete a therapy but do not maintain contact with the clinic.  There are also high costs associated with generating follow-up data.  It is apparent that alternative clinics face many hardships in gaining public acceptance, but this does not mean they are beyond inspection.  Every alternative medicine clinic and/or health care provider should be questioned thoroughly by the patient before any treatment is agreed upon. 

Another problem CAM therapies face is the difficulty in determining what constitutes a positive response to treatment in the eyes of the medical community.  The NCCAM believes that CAM therapies need to be investigated using the same scientific methods applied in conventional medicine.  The NCCAM encourages "applying at least as rigorous, and in some cases, even more rigorous research methods than the current standard in conventional medicine.  This is because research often involves novel concepts and claims, and uses complex systems of practice that need systematic, explicit, and comprehensive knowledge and skills to investigate."  Unfortunately, many CAM therapies are very difficult to fit into standard double-blind clinical trials, the gold standard for proof of effectiveness in medical research.  For instance, with acupuncture, massage and chiropractic, it is apparent to both patient and physician who is receiving the “real” treatment.

Unfortunately, many responses patients may have to CAM therapies are difficult to measure in scientific units.  If the treatment is not shown to be curative or increase life expectancy but does appear to promote and enhance quality of life issues such as increased energy, appetite, sleep and general well-being, how can these be quantified and proven by the scientific method?  For a few therapies, most notably psychological treatments such as psychotherapy, imagery and cancer support groups, scientific studies have reported improved quality of life and possible survival advantages for patients using those treatments.  The available scientific documentation will most probably promote psychotherapy into mainstream medical practices.  If so, its use will become part of the standard treatment protocol for cancer. 

D.  Making the Decision to Pursue Complementary and Alternative Therapies

There is no consensus in the medical community as to when to consider CAM treatment.  Certainly, complementary therapies to promote wellness and optimize overall health are encouraged at any point in time.  If you are considering CAM therapies to manage specific disease symptoms and/or to treat cancer, discuss them with your conventional medical doctor(s).  Great care must be exercised if you decide to forego standard treatments and choose to use only an alternative treatment.  Generally, patients who forego conventional medicine do so because doctors have said that standard treatments can no longer help them or they have had poor experiences with "mainstream" medicine. As will be discussed in later sections, we encourage you to involve your medical team in any decisions you make about your cancer treatment.  Together you can decide what the potential benefits and/or risks associated with combining the options you are considering with, or in place of, standard treatments.

            When researching the different CAM therapies, a distinction between words like “effective” versus “palliative,” and “not curative,” should be made.  When assessing a treatment, the word "cure" should be viewed with skepticism because its use can be extremely ambiguous and misleading.  Generally, "cure" refers to a medical treatment that relieves the patient of his/her disease.  If the wording of a study is confusing, asking a health care provider for assistance might offer some clarity.

The American Cancer Society supports that "cure" or "remission" statements associated with alternative treatments can be misleading for the following reasons:

1.      Patients may have a form of cancer that is progressing slowly and not manifesting any symptoms, but the alternative treatment is still credited with extending life span.

2.      Patients may have had a nonmalignant tumor that has essentially disappeared by itself, but credit is given to the alternative treatment for curing the malignancy.

3.      Patients who have just recently received a course of standard therapy, then switched over to a CAM program, may be experiencing regression due to the effects of the original treatment.  But again, credit is given to the alternative therapy.

However, in cases where there is unusual progress of a patient who begins an alternative therapy immediately after conventional treatment, and odds were significantly against such progress, some success may be credited to the alternative therapy.

E.  Final Considerations

When considering complementary and alternative therapies, you should feel free to ask numerous questions of your health care providers.  Questions might include:

• How effective is and what benefits can be expected from this therapy?

• Is the therapy meant to cure cancer or to help conventional treatments work better?

• What types of cancer respond best to the therapy?

• What is the duration of the treatment?

• What are the risks associated with this therapy?

• Do the known benefits outweigh the risks?

• What side effects can be expected?

• What are the cure or remission rates and how are the statistics/data generated?

• Are there any medical records or clinical trials offering scientific support of treatment?

• Will the therapy interfere with conventional treatment?

• What are the doctors' credentials?  Are they recognized experts in cancer treatment?

• Will the therapy be covered by health insurance?

You should also ask and expect to speak with former patients.  Former patients may provide valuable information on a clinic or treatment.  Often, former patients can provide more legitimate and quantifiable results regarding treatment than clinics actively recruiting patients.  However, keep in mind that it is less likely you will be put in contact with people who were not helped by the treatment than those who experienced dramatic positive results.  The patient you are allowed to speak with may be one out of one hundred who actually benefited from the treatment.  Ask to be put in contact with several former patients if possible.  Remember that patient testimonials used alone do not adequately assess the effectiveness of a CAM therapy, and great care should be taken when deciding whether or not it is your exclusive criteria for selecting a therapy.

            Once you commit to an alternative therapy, it should be given a fair chance to work.  The duration of different treatments can vary significantly and therefore, you must fully understand the time involved in the therapy and organize your daily activities accordingly.  Strong support from family and friends is vital to help patients complete treatments.  All too often, patients discontinue treatment because family members are not willing to conform to guidelines designated by many therapies.  Patients are encouraged to reach an agreement and discuss potential difficulties with family members before treatment begins.

            As with conventional treatments, costs are an important factor to consider.  Most insurance companies will not cover the costs of alternative, experimental or unproven cancer therapies, but some are beginning to offer coverage of some of the more widely accepted complementary methods of treatment such as acupuncture and chiropractic therapy.  In 2000, 30 major insurers, including Blue Cross and Medicare, covered at least one complementary method of treatment. 

Contact your insurance company to find out what, if any, CAM therapies are covered by your plan.  Financial arrangements should be carefully discussed with both the alternative care center and the insurance company before beginning treatment.  It is a good idea to have all costs agreed upon and in writing ahead of time.

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