Elsevier

Seminars in Oncology

Volume 29, Issue 6, December 2002, Pages 531-545
Seminars in Oncology

Complementary and alternative medicine: Opportunities and challenges for cancer management and research*,**

https://doi.org/10.1053/sonc.2002.50002Get rights and content

Abstract

Given the widespread use of diverse complementary and alternative medicine (CAM) approaches by cancer patients, research to establish their safety and efficacy is critical as is improved patient-physician communication about their possible risks and benefits. The mission of the National Center for Complementary and Alternative Medicine (NCCAM) is to support exacting research and disseminate clear and compelling information on CAM. Although many of the challenges facing such research are not unique to CAM, these approaches do present unique challenges, but the opportunities are many for prevention, palliation, and even treatment. Using the current research portfolio of NCCAM to illustrate how the field may mature, this report summarizes the challenges facing CAM investigators, the most fruitful areas for exploration, and existing information resources. Semin Oncol 29:531-545. This is a US government work. There are no restrictions on its use.

Section snippets

Opportunities for CAM

The complex physical and psychosocial needs of cancer patients along the disease trajectory lend themselves to the kinds of people-oriented approaches of CAM. As more comprehensive and community cancer treatment centers recognize the need to expand treatment options for patients, they have begun to provide selected CAM programs, education, and services. A survey of 56 National Cancer Institute (NCI)-designated cancer centers (46% response rate) found that 65% of patient educators in the Cancer

Challenges for CAM research

The design and conduct of exacting and meaningful CAM research presents a number of unique challenges for investigators. First, traditional systems of medicine such as TOM or Ayurveda from the Indian subcontinent consist of multimodal therapies, yet studies of these complex systems often take a minimalist approach by evaluating one or two modalities, taken out of context. Numerous studies, for example, have evaluated the efficacy of acupuncture needling alone. Yet, acupuncture is but one of an

Reliable sources for information about CAM

Cancer patients and the public are literally bombarded with information about CAM. Rumors, the media, and the Internet spread some accurate and inaccurate information at ever accelerating rates.85 It is critical that both patients and physicians have access to reliable information. Until recently, however, credible sources for evidence-based information on CAM were limited.86 This situation is changing rapidly.

To meet demands for evidence-based CAM, NCCAM helps fund a CAM field group within the

Mandate for CAM cancer research

To better address the opportunities and challenges of CAM approaches to cancer management, the American public and the medical community have long urged systematic evaluations of their safety and efficacy.90, 91, 92 In turn, there is a long and declared history of government responses to this demand. Congress commissioned a review of unconventional cancer approaches following closure of a Bahamian clinic that provided such services in the mid-1980s.68 The subsequent 1990 “Unconventional Cancer

NCCAM research of CAM cancer therapies

NCCAM designs, develops, reviews, funds, and implements specific CAM research and training programs, both extramurally (outside) and intramurally (on the NIH campus) while coordinating its efforts with those of the other NIH institutes and centers (ICs). The goal is to increase the number of NCCAM-supported grants and encourage cofunding of CAM-related research activities with other ICs. The program awards predoctoral and postdoctoral fellowships in CAM research, as well as institutional grants

Specialized center grants

NCCAM supports two major centers for CAM cancer research using the NIH's specialized center (P50) grant mechanism. The two P50 cancer center grants were awarded in Fall 2000 to Johns Hopkins University in Baltimore and the University of Pennsylvania in Philadelphia. The grant awards provide funding for scientific investigation of efficacy, effectiveness, safety, and validity of CAM practices, as well as studies of the mechanisms underlying these practices. The centers are designed to include

Conclusion

The field of CAM research is in its infancy, but its first steps promise to elevate it to progressively more robust designs and compelling outcomes. Success in this nascent field will require commitment. The public has committed support for the work by the NIH. Yet, that is not sufficient. Experienced and energetic scientists must be willing to take some personal risks to enter this field. Otherwise, the public health implications of CAM approaches to cancer (both positive and negative) will

References (116)

  • MK Steuer-Vogt et al.

    The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: A randomised controlled clinical trial

    Eur J Cancer

    (2001)
  • U Kleeberg et al.

    Adjuvant trial in melanoma patients comparing rIFN-alpha to rIFN-gamma to Iscador to a control group after curative resection of high-risk primary or regional lymph node metastasis (EORTC 18871)

    Eur J Cancer

    (1999)
  • The National Center for Complementary and Alternative Medicine

    Expanding Horizons of Healthcare: The Five-Year NCCAM Strategic Plan 2001-2005

  • L Arab

    Epidemiologic challenges in the study of the efficacy and safety of medicinal herbs

    Public Health Nutr

    (2000)
  • D Eisenberg et al.

    Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey

    JAMA

    (1998)
  • D Eisenberg et al.

    Unconventional medicine in the United States: Prevalence, costs, and patterns of use

    N Engl J Med

    (1993)
  • P Wolsko et al.

    Insurance coverage, medical conditions, and visits to alternative medicine providers: Results of a national survey

    Arch Intern Med

    (2002)
  • E Ernst et al.

    The prevalence of complementary/alternative medicine in cancer. A systematic review

    Cancer

    (1998)
  • KM Kelly et al.

    Use of unconventional therapies by children with cancer at an urban medical center

    J Pediatr Hematol Oncol

    (2000)
  • MA Richardson et al.

    Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology

    J Clin Oncol

    (2000)
  • MM Lee et al.

    Alternative therapies used by women with breast cancer in four ethnic populations

    J Natl Cancer Inst

    (2000)
  • K Munstedt et al.

    Unconventional cancer therapy: Survey of patients with gynecological malignancy

    Arch Gynecol Obstet

    (1996)
  • HJ Burstein et al.

    Use of alternative medicine by women with early-stage breast cancer

    JAMA

    (1999)
  • MJ Verhoef et al.

    Alternative therapy use in neurologic diseases

    Neurology

    (1999)
  • SR Adler et al.

    Disclosing complementary and alternative medicine use in the medical encounter: A qualitative study in women with breast cancer

    J Fam Pract

    (1999)
  • H Boon et al.

    Use of complementary/alternative medicine by breast cancer survivors in ontario: prevalence and perceptions

    J Clin Oncol

    (2000)
  • M Lippert et al.

    Alternative medicine use in patients with localized prostate carcinoma treated with curative intent

    Cancer

    (1999)
  • W Sollner et al.

    Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior

    Cancer

    (2000)
  • R Moschen et al.

    Use of alternative/complementary therapy in breast cancer patients—A psychological perspective

    Support Care Cancer

    (2001)
  • C Gotay et al.

    Use of complementary and alternative medicine in Hawaii cancer patients

    Hawaii Med J

    (1999)
  • A Sparber et al.

    Use of complementary medicine by adult patients participating in cancer clinical trials

    Oncol Nurs Forum

    (2000)
  • J Weis et al.

    Complementary medicine in cancer patients: Demand, patients' attitude, and psychological belief

    Onkologie

    (1998)
  • SD Begbie et al.

    Patterns of alternative medicine use by cancer patients

    Med J Aust

    (1996)
  • W Sollner et al.

    Attitude toward alternative therapy, compliance with standard treatment, and need for emotional support in patients with melanoma

    Arch Dermatol

    (1997)
  • CV Fernandez et al.

    Alternative and complementary therapy use in pediatric oncology patients in British Columbia: Prevalence and reasons for use and nonuse

    J Clin Oncol

    (1998)
  • MG Sawyer et al.

    The use of alternative therapies by children with cancer

    Med J Aust

    (1994)
  • D Oneschuk et al.

    The use of complementary medications by cancer patients attending an outpatient pain and symptom clinic

    J Palliat Care

    (1998)
  • IJ Lerner et al.

    The prevalence of questionable methods of cancer treatment in the United States

    CA Cancer J Clin

    (1992)
  • RS DiPaola et al.

    Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer

    N Engl J Med

    (1998)
  • D Labriola et al.

    Possible interactions between dietary antioxidants and chemotherapy

    Oncology

    (1999)
  • D Lamson et al.

    Antioxidants in cancer therapy; their actions and interactions with oncologic therapies

    Altern Med Rev

    (1999)
  • S Zeisel et al.

    Special commentary: Antioxidants and nutrition support

    Curr Opin Clin Nutr Metab Care

    (1999)
  • K Conklin

    Dietary antioxidants during cancer chemotherapy: Impact on chemotherapeutic effectiveness and development of side effects

    Nutr Cancer

    (2000)
  • A Washburn

    Complementary therapies: A survey of NCI cancer patient educators

    Cancer Pract

    (2000)
  • ML Slevin et al.

    Attitudes to chemotherapy: Comparing views of patients with cancer with those of doctors, nurses, and general public

    Br Med J

    (1990)
  • D Jeffrey

    Education in palliative care: A qualitative evaluation of the present state and the needs of general practitioners and community nurses

    Eur J Cancer Care (Engl)

    (1994)
  • KG Wallace

    Analysis of recent literature concerning relaxation and imagery interventions for cancer pain

    Cancer Nurs

    (1997)
  • NIH Consensus Development Panel on Acupuncture

    Acupuncture

    JAMA

    (1998)
  • J Shen et al.

    Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial

    JAMA

    (2000)
  • MA Richardson et al.

    Acupuncture for chemotherapy induced nausea and vomiting in cancer patients (Protocol for a Cochrane Review), in: The Cochrane Library

    (2002)
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    *

    Address reprint requests to Mary Ann Richardson, DrPH, National Institutes of Health, Center for Alternative and Complementary Medicine, 6707 Democracy Blvd, Suite 106, Bethesda, MD 20892-5475.

    **

    This is a US government work. There are no restrictions on its use.

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