Complementary and Alternative Medicine: Intro to Evidence-Based Guidelines

The American College of Chest Physicians (ACCP) recently published multiple papers of evidence-based guidelines for many aspects of lung cancer, and among these was a provocative one about complementary and alternative medicines (CAM)(abstract here). These guidelines are novel because they attempt to compile the evidence about CAM, a broad topic about which there is a great deal of interest but not nearly enough clinical trials or evidence. Among the first points is that complementary and alternative are two different things, with complementary really being defined, as the name implies, as an adjunct combined with the current standard “mainstream” treatments, primarily given to minimize side effects and integrate to enhance patient well-being. In contrast, alternative approaches tend to either be unproven or even disproved strategies that are often promoted instead of mainstream treatments for cancer. The latter are far more problematic for oncologists, because it is often detrimental to the health of patients to delay or refuse standard treatments for cancer altogether. Complementary treatments are often eventually tested, sometimes found to be beneficial, and then combined with chemo, radiation, and other standard anticancer approaches as part of an “integrated oncology program”. Alternative medical approaches are less commonly subjected to clinical trials and have not, as a rule, been demonstrated as beneficial if they have been tested. Alternative therapies are more commonly aggressively promoted as a biologically active easy cure in lieu of standard and better tested treatments.

One key principle is that CAM in one form or another is commonly used by patients, estimated at about 50%, and up to about 75% if prayer specifically for health reasons is included; moreover, much of the research suggests that use of CAM approaches has increasing (full text article here). Because of that, one of the recommendations is that physicians specifically ask patients about their use of CAM.

The guidelines include commentary on topics ranging from acupuncture, for which there are actually a number of studies on it as a treatment for pain or nausea, to massage therapy, vitamins and herbal supplements, massage therapy, bioenergy fields, and other work. I’ll cover these topics in my next several posts, and I’ll invite Dr. Labriola to provide his commentary in order to add further information that may support or refute my input.

Complementary and Alternative Medicine (CAM) and Cancer Survivors: Guest Post by Dr. Labriola

Does it work? Is it safe? How do we know?

Vitamins, minerals, amino acids, herbs (botanicals), enzymes, hormones, infra-red, ultraviolet, and the list goes on of potential CAM treatments for cancer. Some have potential benefit, while others either have no effect or can actually cause harm, but how do you know which are which? The problem is compounded by claims from salespersons including some “doctors” and scientific studies that contradict other studies.

Not a day goes by in practice that I’m not asked about some new herbal or other treatment for cancer. I base my advice on a few guidelines which I have described here for OncTalk visitors. I hope you will find this a useful tool for finding your way through the jungle of claims and suggestions on the internet, from salespersons and well-meaning relatives and friends. Read the rest of this entry »

New and Improved: Naturopathic Physician Input at OncTalk

It has been consistently demonstrated that interest in supplements, naturopathic medicine, and complementary and alternative medicine (CAM)approaches has increased very significantly among patients receiving treatment for cancer in the US over the last several years. One reflection of that is the array of questions coming in to the Discussion/Q&A Forum here, and/or comments after the posts I write, which often ask questions to which I have little insight to offer. Well, I could just punt, make up an answer, or do something more helpful, which is collaborate with someone who actually CAN provide a more thorough answer to questions in the realm of naturopathic medicine and CAM.

Dan Labriola, ND, is a practicing Naturopathic Physician, the Director and Founder of the Northwest Natural Health Specialty Care Clinic in Seattle, WA. He is also Director of Naturopathic Services for the Swedish Cancer Institute, where I work as a medical oncologist. We work at the same institution because we all recognize that allopathic medicine and CAM are often not viewed as mutually exclusive concepts, but rather many patients seek a combination of approaches. Dr. Labriola is a naturopath with whom I and many other oncologists in the Seattle community share a very strong relationship, as I recognize that he works with patients to clarify where there is evidence to support CAM approaches, where there are limitations, and where there may be potential adverse effects in which supplements or other aspects of CAM may potentially interfere with the rest of the cancer treatment care plan. Read the rest of this entry »