Complementary and alternative medicine: Opportunities and challenges for cancer management and research*,**
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)
- et al.
The use of complementary therapies by breast cancer patients attending conventional treatment
Eur J Cancer
(1998) - et al.
Prevalence of complementary therapy use by women with breast cancer: A population-based survey
Eur J Cancer
(2000) - et al.
The use of non-proven therapy among patients treated in Norwegian oncological departments: A cross-sectional national multicenter study
Eur J Cancer
(1995) Harmless herbs? A review of the recent literature
Am J Med
(1998)- et al.
Free radicals and antioxidants in chemotherapy-induced toxicity
Cancer Treat Rev
(1997) Can unorthodox cancer therapy improve quality-of-life?
Ann Oncol
(1993)- et al.
Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review
J Pain Symptom Manage
(2000) - et al.
Complementary and alternative medicine in early-stage breast cancer
Semin Oncol
(2001) - et al.
The role of transcutaneous electrical stimulation of Neiguan anti-emetic acupuncture point in controlling sickness after chemotherapy
Physiotherapy
(1991) - et al.
Mistletoe treatment for cancer. Review of controlled clinical trials
Phytomedicine
(1994)
The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: A randomised controlled clinical trial
Eur J Cancer
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
Expanding Horizons of Healthcare: The Five-Year NCCAM Strategic Plan 2001-2005
Epidemiologic challenges in the study of the efficacy and safety of medicinal herbs
Public Health Nutr
Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey
JAMA
Unconventional medicine in the United States: Prevalence, costs, and patterns of use
N Engl J Med
Insurance coverage, medical conditions, and visits to alternative medicine providers: Results of a national survey
Arch Intern Med
The prevalence of complementary/alternative medicine in cancer. A systematic review
Cancer
Use of unconventional therapies by children with cancer at an urban medical center
J Pediatr Hematol Oncol
Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology
J Clin Oncol
Alternative therapies used by women with breast cancer in four ethnic populations
J Natl Cancer Inst
Unconventional cancer therapy: Survey of patients with gynecological malignancy
Arch Gynecol Obstet
Use of alternative medicine by women with early-stage breast cancer
JAMA
Alternative therapy use in neurologic diseases
Neurology
Disclosing complementary and alternative medicine use in the medical encounter: A qualitative study in women with breast cancer
J Fam Pract
Use of complementary/alternative medicine by breast cancer survivors in ontario: prevalence and perceptions
J Clin Oncol
Alternative medicine use in patients with localized prostate carcinoma treated with curative intent
Cancer
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
Use of alternative/complementary therapy in breast cancer patients—A psychological perspective
Support Care Cancer
Use of complementary and alternative medicine in Hawaii cancer patients
Hawaii Med J
Use of complementary medicine by adult patients participating in cancer clinical trials
Oncol Nurs Forum
Complementary medicine in cancer patients: Demand, patients' attitude, and psychological belief
Onkologie
Patterns of alternative medicine use by cancer patients
Med J Aust
Attitude toward alternative therapy, compliance with standard treatment, and need for emotional support in patients with melanoma
Arch Dermatol
Alternative and complementary therapy use in pediatric oncology patients in British Columbia: Prevalence and reasons for use and nonuse
J Clin Oncol
The use of alternative therapies by children with cancer
Med J Aust
The use of complementary medications by cancer patients attending an outpatient pain and symptom clinic
J Palliat Care
The prevalence of questionable methods of cancer treatment in the United States
CA Cancer J Clin
Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer
N Engl J Med
Possible interactions between dietary antioxidants and chemotherapy
Oncology
Antioxidants in cancer therapy; their actions and interactions with oncologic therapies
Altern Med Rev
Special commentary: Antioxidants and nutrition support
Curr Opin Clin Nutr Metab Care
Dietary antioxidants during cancer chemotherapy: Impact on chemotherapeutic effectiveness and development of side effects
Nutr Cancer
Complementary therapies: A survey of NCI cancer patient educators
Cancer Pract
Attitudes to chemotherapy: Comparing views of patients with cancer with those of doctors, nurses, and general public
Br Med J
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)
Analysis of recent literature concerning relaxation and imagery interventions for cancer pain
Cancer Nurs
Acupuncture
JAMA
Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial
JAMA
Acupuncture for chemotherapy induced nausea and vomiting in cancer patients (Protocol for a Cochrane Review), in: The Cochrane Library
Cited by (61)
End of Life in Pediatrics: The “Relief” of Poetry on Pain by Reaching Children's Spirituality
2023, Journal of Pain and Symptom ManagementCitation Excerpt :In particular, the nociceptive experience involves not only the primitive stimulus, but also the emotional status, social context and spirituality he/she is living during the occurrence of the symptom.18,19 It is extremely important to pay attention to reduce the child's levels of perceived stress and anxiety, especially by resorting to those non-pharmacological treatments that include art and music therapy,20 but also through developmentally normative play, which is useful in helping patients to transcend medical-related stress.21–23 Such non-pharmacological treatments are aimed at providing a process of mental dissociation and distraction, taking advantage of the considerable imagination of children.24
Efficacies and side effects of medicinal plants used by patients with cancer in Morocco: A retrospective treatment-outcome study
2023, Journal of EthnopharmacologyCitation Excerpt :Another review, including all ethnopharmacological studies (from 1991 to 2019), identified 103 plants used as anticancer drugs in Morocco (Alami Merrouni and Elachouri, 2021). The toxicity of herbal medicines arouses interest because plants with biological activity may mask, alter or interact with conventional drugs or exert direct side effects (Poonthananiwatkul et al., 2015; Richardson and Straus, 2002). The increased use of herbal medicines has contributed to the occurrence of adverse events, such as hypersensitivity and cardiac, hepatic, and renal toxicity (Shaw et al., 2012).
Red ginseng and cancer treatment
2016, Chinese Journal of Natural MedicinesPerception and attitude of Jordanian physicians towards complementary and alternative medicine (CAM) use in oncology
2013, Complementary Therapies in Clinical PracticeCitation Excerpt :The same study reported that about 78% of CAM users didn't discuss the issue of using CAM with their healthcare providers.7 Given the high prevalence of CAM use among cancer patients, added to the fact that most cancer patients do not disclose CAM use to their oncologists,7,8 and the potential of harmful drug–herb–vitamin interactions,9–11 clinical awareness regarding this use is crucial. Patients often rely on their doctors for information and guidance about treatment decisions.12
Simply because it works better: Exploring motives for the use of medical herbalism in contemporary U.K. health care
2009, Complementary Therapies in MedicineEfficacy of a plant extract (Chelidonium majus L.) in combating induced hepatocarcinogenesis in mice
2008, Food and Chemical ToxicologyCitation Excerpt :More in-depth research on this plant towards development of specific drug against specific liver ailments may be rewarding, particularly in view of certain plant extracts showing potentials of CAM for use in cancer therapy (Bruss, 2000; Balzarini et al., 2000; Richardson and Straus, 2002; Khuda-Bukhsh, 2003, 2006; Pathak et al., 2006, 2007).
- *
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.