Tuesday, August 07, 2007

Complementary Medicine and Cancer

WebMd.com seems to really like acupuncture based on the idea that it can do very little (to no) harm and has some positive research. The complex topic of herbs with cancer they do not look on favorably. This is not surprising given the fact that there is so much misinformation and fear/caution about herbal treatments with cancer patients. When I work with a cancer patient I am communicating with the patients' doctor so as not to interfere with conventional treatment and keep the Dr. apprised of what may be helping the patients. There are however, many "non-interfering" periods of cancer treatment where complimentary can be of use.

Acupuncture can be used nearly all the time. Although there is a theoretical caution about using acupuncture when white blood cell counts are low due to possible risk of infection.

Herbs, supplements can be used for a cancer patient safely when prescribed properly in all the following situations
  • Before and during intervals of conventional treatment
  • When a patient is not receiving treatment
  • During conventional treatment to relieve side effects. The research seems mostly weak describing ways to take supplements to improve chemotherapy treatment efficacy.
  • pre surgery preparation, recovery from surgery
  • Post treatment side effects
  • prevention
Treating a cancer patient with herbs and acupuncture is not just about treating cancer. By law I am not allowed to do this. However, within the diagnositic scope of my License as a California Acupuncturist I diagnose blood stagnation, phlegm accumulation, organ imbalances and other variations. The remarkable thing is that this approach to balancing the body that is germane to Chinese Medicine has tremendous benefit to patients and has for a very long time. While the oncologist tends to be focused on disease, I am focused on balancing the patient. Both have a place in the care of cancer patients. Alex

Also called alternative medicine, is the complementary approach a new model for Western medicine?
By R. Morgan Griffin
WebMD Feature
Reviewed by Louise Chang, MD

A few years ago, if you asked your oncologist for a referral to a masseuse, she'd think you were joking. But things have changed. Nowadays, your oncologist might be prescribing the massage -- along with acupuncture, herbs and other therapies.

It's a sign of a new trend: complementary medicine (also called integrative medicineintegrative medicine) is making its way into the mainstream, combining standard medical treatments with complementary ones. Some hospitals have even set up entire integrative medicine centers -- largely because of patient demand.

"Patients love it," says Simone Zappa, RN, an administrator in the Integrative Medicine Department at Memorial Sloan-Kettering Cancer Center in New York. "And they love it because it works."

Complementary treatments help many people with cancer. Massage, acupuncture, and hypnosis are being used along with radiation, chemotherapy, and surgery. These complementary therapies aren't usually intended to treat the cancer itself. But they can ease side effects and improve quality of life. They may even reduce the amount of medicine you need for treatment.

What's more, some of these treatments have been shown to work in scientific studies. The gulf between evidence-based Western medicine and traditional therapies is not as wide as it once was. And many people with cancer are benefiting.

Understanding Complementary Medicine

Complementary medicine includes dozens of treatments that have not been generally used in Western medicine. They extend from nutritional changes, to biofeedback, to yoga.

Experts stress that complementary or integrative medicine is not the same as "alternative medicine." Complementary medicine for cancer is a complement -- not a replacement -- for traditional treatments like radiation, chemotherapy, and surgery. It's an important distinction, since only conventional therapies have been shown to fight cancer.

People with cancer seek out complementary medicine for many reasons. Zappa says that, at Sloan-Kettering, she most often sees people suffering from pain, nausea, depressiondepression, anxiety, and fatiguefatigue. Some are wary of the unusual approach at first. But most are convinced after they try it, says Zappa. "What's great about the integrative approach is that it gives back a feeling of control."

Complementary Medicine's New Converts

For hardened skeptics, phrases like "traditional healing techniques" and "alternative medicine" conjure up images of magic crystals and the smell of incense. But in fact, the people researching complementary medicine -- and sometimes even practicing it -- are likely to be wearing lab coats.

"The people doing this work are not crackpots," says Heather S. Shaw, MD, co-director of the Integrative Oncology Program at Duke University. "I'm an oncologist and I spend a lot of my time parked on a laboratory bench doing research."

Indeed, hospitals with complementary medicine divisions are spearheading research. Experts are using the same rigor in evaluating complementary therapies that they would in testing drugs or surgery. It's not enough to assume that a treatment works just because it's been used for thousands of years. Doctors want evidence.

After seeing the benefits of complementary medicine, many doubting oncologists have been convinced.

"My colleagues used to think I was nuts," Shaw says. "They teased me about prescribing so-called 'herbs and spices'." But now her fellow doctors are always asking her advice on new ways to help their patients.

The Integrative Approach: Is It Proven?

Of course, here's the big question: do we know if complementary medicine really works?

The answer: It depends on the specific treatment. Acupuncture and massage -- which not so long ago were considered pretty far-out -- have been shown to help. Many studies have shown that acupuncture eases chemotherapy nausea, while other studies suggest acupuncture and massage may reduce pain from cancercancer or its treatment.

"A lot of oncologists don't see acupuncture or massage as 'alternative medicine' anymore," says Shaw. "These therapies are so well established that they've become standard."

Other complementary techniques aren't as well researched. So when a treatment is unproven, the question is whether its potential benefits outweigh its risks. If it's risky, it isn't used. But if the risks are very, very low, doctors may be more open.

"If a treatment is safe but unproven, why not give it a try if the patient is interested?" says David S. Rosenthal, MD, medical director of the Center for Integrated Therapies at the Dana Farber Cancer Institute.

Things get trickier with herbal and botanical supplements. Despite their wide popularity, few have been shown to be either safe or effective against cancer. On the other hand, some have been shown to be both ineffective and unsafe. One example is laetrile, which contains a substance found in the pits of some fruits. The active ingredient seems to be cyanide, and it has resulted in symptoms of cyanide poisoning. Some common supplements -- like St. John's wort and high doses of vitamin C -- can interact with chemotherapy and radiation.

"You have to be very careful with botanical and herbal supplements," says Zappa. "They are real drugs and we just don't know a lot about them." She hopes future research will show benefits. But for now, she and other experts urge caution. Given the risks, your doctor must know about all of the herbs, botanicals, and supplements you use.

Will My Insurance Pay for Complementary Medicine?

By and large, insurance companies don't cover complementary care. Specifics vary with each insurer and from state to state. For instance, acupuncture is covered in some states but not others, says Rosenthal.

For now, most complementary medicine is provided on a fee-for-service basis. But advocates of integrative medicineintegrative medicine say this is likely to change.

"A lot of us are doing research now that, we hope, will show the benefits of these therapies," says Rosenthal. "Once we have the evidence, we can make a case to the insurance companies."

Shaw agrees. "We're hoping to show that these treatments will actually save insurers money," she says. "They may reduce hospitalizations and drug costs."

Finding a Complementary Medicine Caregiver

A lot of people may offer "complementary medicine." But how do you know if they're reputable? It's hard to be sure.

You're lucky if you live near a teaching hospital with a complementary or integrative medicine center. Many offer complementary services right in the hospital. If you're not close to such a center, talk to your doctor. He or she may know of people practicing complementary medicine in your area.

You should also look for credentials. For instance, acupuncturists should either have an LAc or be a Doctor of Oriental Medicine, says Shaw. You can see if your state licenses acupuncturists and other providers. The National Center for Complementary and Alternative Medicine has tips for finding qualified caregivers.

Shaw has two rules of thumb when judging good complementary medicine providers. First, they will not make any claims to cure cancercancer. Second, they will not try to convince you to stop conventional therapy. If a practitioner does either, you should find someone else.

There's also the flip side. If you are interested in complementary therapies, it's important your oncologist be open to them. Not every doctor is. Some flat out demand that their patients stop using all complementary therapies, since they don't know enough about them, says Shaw.

"If you want complementary therapies and your oncologist is adamantly opposed to them, you might want to find someone else," says Shaw. "There are a lot of open-minded oncologists out there who will help you."

But Zappa predicts that opposition to integrative medicine will become more and more rare.

"People in medicine are scientists, and scientists rightly need proof that treatments work," she tells WebMD. "But now we finally have a lot of good research coming out. Once the research is out there, no one can ignore it. These treatments really do help people feel better."

WebMD Feature

Published Oct. 23, 2006.SOURCES: American Cancer Society web site, "Complementary and Alternative Therapies." Corbin, L. Cancer Control, July 2005; vol 12: pp 158-164. Memorial Sloan-Kettering Cancer Center web site, "Individual Therapies." National Cancer Institute, "Acupuncture PDQ," "Complementary and Alternative Medicine in Cancer Treatment: Questions and Answers." David S. Rosenthal, MD, professor of medicine, Harvard Medical School; medical director, Leonard P. Zakim Center for Integrated Therapies at the Dana Farber Cancer Institute, Boston. Heather S. Shaw, MD, assistant professor of medicine, Multidisciplinary Breast Program, Duke University Medical Center. Simone Zappa, RN, administrator, Integrative Medicine Department, Memorial Sloan-Kettering Cancer Center, New York. U.S. Department of Health and Human Services, "Thinking about Complementary and Alternative Medicine."
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