Unconventional Cancer Treatments: Complementary Truths vs. Alternative Facts
By: Meital Yerushalmi
The deadly truth behind alternative cancer therapies, featured in our last issue, raises the danger in resorting to unsubstantiated alternative therapies as means of curing one’s cancer.
Though many such anecdotal “cures” exist online that may lure patients away from conventional care, the article begs the question—are all non-conventional cancer treatments created equal?
The interest in therapies outside conventional oncology is not limited to alternative treatments. It is estimated that 40% of cancer patients worldwide use alternative or complementary therapies, and that 40% of American cancer survivors use complementary therapies following their treatment (1, 2). The distinction between the two is important: whereas alternative methods are those used instead of conventional care, complementary therapies are used alongside conventional methods to help relieve their side effects, ease pain, and improve symptoms and quality of life (3). And while the former is unequivocally discouraged by the medical community, the jury is still out on the latter.
Or is it? Evidence is emerging in support of complementary modalities in cancer patients, ranging from mind-body therapies to body-based practices and supplements. Systematic reviews and meta-analyses of numerous clinical trials of mind-body techniques (including meditation, relaxation, yoga, and mindfulness-based approaches) in cancer patients have consistently shown their efficacy in reducing anxiety and stress and improving sleep quality and overall quality of life (3, 4). In addition, acupuncture was shown to be safe and effective for several symptoms of cancer patients including chemotherapy-induced nausea and vomiting, as concluded by a Cochrane review of 11 randomized control trials (RCTs) (5, 6). Similarly, two systematic reviews of cancer-related RCTs concerning massage therapy concluded that while the research methodology of most trials included was poor (due to small sample size or lack of control for nonspecific effects), the data do support massage therapy as an effective adjunct in supporting cancer care to reduce anxiety and pain (7, 8). Yet, evidence regarding supplements alongside conventional cancer care is less clear. Vitamin D has been the subject of many studies to investigate its role in cancer, as its optimal status may be associated with fewer occurrences of cancer. And while a Cochrane review of its supplementation shows a benefit in decreasing cancer mortality, the current state of evidence is not sufficient to draw firm, universal conclusions about its benefits in cancer patients (9, 10). Additionally, albeit less extensively, meta-analyses of RTCs also support probiotics in preventing radiation-induced diarrhea and melatonin in reducing side effects of chemotherapy (11, 12). High-dose vitamin C, curcumin, and other supplements remain controversial due to the inconclusive state of evidence regarding their safety and efficacy.
Ostensibly, the term complementary and alternative medicine (CAM) is problematic particularly in the realm of cancer therapies, for it relates two principally distinct—and often mutually contradictory—concepts. In lieu of this outdated term, Integrative Medicine (IM) has been increasingly used to refer to the complementary treatments used in medical settings alongside conventional practices. Similarly, Integrative Oncology refers to patient-centered, evidence-informed cancer care that utilizes complementary approaches alongside conventional cancer treatments.13 Currently, the US Consortium of Academic Health Centers for Integrative Medicine has a membership of 55 esteemed academic medical centers and schools that have IM programs, including in oncology. Notable members of the Consortium include the Mayo Clinic, Stanford, John Hopkins, Harvard, and the University of Toronto (14). The latter’s Centre for Integrative Medicine not only aims to support IM research but also mandates to train conventional health professionals and collaborate with clinical partners on developing integrative health care services (15).
When patients seek complementary cancer treatments, oncology teams work to maintain the delicate balance between providing patient-centered and evidence-based care. Resources and guidelines (16, 17) are available regarding the safety and efficacy of complementary treatments, which can help care teams approach the issue in a compassionate, yet evidence-based fashion that enhances trust and rapport with patients, and improves quality of life for patients and their caregivers. Integrating these care models requires a critical, yet balanced evaluation of the evidence rather than a global repudiation of all complementary treatments; in other words, let us not throw the baby out with the bathwater.
I would like to thank Dr. Daniel Lander, ND and Dr. Jill Shainhouse, ND for their help with the background research for this article.
- 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. 2008;113(5):1048-57.
- Horneber M, Bueschel G, Dennert G, et al. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012;11(3):187-203.
- Deng G, Cassileth B. Complementary or alternative medicine in cancer care-myths and realities. Nat Rev Clin Oncol. 2013;10(11):656-64.
- Piet J, Wurtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. J Consult Clin Psychol. 2012;80(6):1007-20.
- Garcia MK, McQuade J, Haddad R, et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol. 2013;31(7):952-60.
- Ezzo JM, Richardson MA, Vickers A, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev. 2006(2):CD002285.
- Ernst E. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials. Support Care Cancer. 2009;17(4):333-7.
- Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer: systematic review. J Adv Nurs. 2008;63(5):430-9.
- Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2014(1):CD007470.
- Theodoratou E, Tzoulaki I, Zgaga L, et al. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:g2035.
- Liu MM, Li ST, Shu Y, et al. Probiotics for prevention of radiation-induced diarrhea: A meta-analysis of randomized controlled trials. PLoS One. 2017;12(6):e0178870.
- Seely D, Wu P, Fritz H, et al. Melatonin as adjuvant cancer care with and without chemotherapy: a systematic review and meta-analysis of randomized trials. Integr Cancer Ther. 2012;11(4):293-303.
- Witt CM, Balneaves LG, Cardoso MJ, et al. A Comprehensive Definition for Integrative Oncology. J Natl Cancer Inst Monogr. 2017;2017(52).
- Member Listing: Academic Consortium for Integrative Medicine & Health; 2018. Available from: https://www.imconsortium.org/members/members.cfm.
- About the Centre for Integrative Medicine: Leslie Dan Faculty of Pharmacy. Available from: http://www.pharmacy.utoronto.ca/cim/about.
- Memorial Sloan Kettering Cancer Center 2017. Available from: https://www.mskcc.org/.
- Cassileth BR, Deng GE, Gomez JE, et al. Complementary therapies and integrative oncology in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):340S-54S.