What is the role of complementary or alternative medicine in the management of breast cancer?

OVERVIEW: The increasing recognition of the importance of supportive measures in breast cancer management has led to the widespread availability of complementary modalities, such as acupuncture, massage and music therapy. The Internet has contributed to the dissemination of information on alternative treatment modalities, some of which may interfere with conventional cancer treatment strategies.

COMPLEMENTARY AND ALTERNATIVE MEDICINE THE SCOPE OF ALTERNATIVE MEDICINE IN ONCOLOGY

There are many products and approaches promoted on the Internet and in magazines as alternatives to mainstream care that are touted as natural, easy, simple cures to cancer. About 75% of cancer patients try something over-the-counter or some kind of alternative remedy, although not necessarily exclusively.

We know from extrapolation of previous research that about 8 - 10 percent of newly diagnosed patients — tissue biopsy-diagnosed patients with all kinds of cancers — go directly to an alternative practitioner. This is a very serious problem. It’s a small percentage of the total, but that small percentage turns out to be a very large number of human beings that we have to worry about. These are patients who will go to an alternative practitioner for six months or a year while their disease continues to grow unabated. When they realize that it’s not working, they eventually go back to the hospital where they were diagnosed or to some other hospital or cancer center. Usually they are beyond hope of cure and sometimes beyond hope of treatment at that point. It’s a very, very sad situation.

—Barrie Cassileth, PhD

MASSAGE AND REFLEXOLOGY

One of the most effective complementary modalities is massage. We have certainly found that to be the case at Memorial. Breast cancer patients seem to thrive on both massage and reflexology (foot massage). Massage is something that one can literally prescribe to a patient, preferably from someone who knows how to do it properly. There is definitely a measured physiologic effect. A good massage, as is true of many of the other complementary modalities, will lower blood pressure, reduce heart rate and have all kinds of beneficial physiologic effects. It also relaxes muscles and, in a circular fashion, relieves distress. It should be done by therapists who are very well-trained, licensed and certified.

Reflexology is a foot massage. It’s based on a non-scientific idea that if you press certain parts of the foot, it will affect the liver, etc. That’s certainly not valid. But the foot massage itself is so wonderful! Patients love it. We’ve actually learned that foot massage for bed-ridden patients helps them get out of bed and walk more quickly and more easily.

—Barrie Cassileth, PhD

DISCUSSIONS OF CAM OFFER OPPORTUNITIES WITH PATIENTS

The suggestion that CAM use is often not about cancer treatment but about feeling better and about having greater control over one’s destiny argues that the most important thing to do about CAM is to talk about it. Oncologists need to “ask the unasked question” and probe directly and specifically for use of alternative therapies or participation in other complementary health-related behaviors. We should expect that the answer will be yes, and the follow-up question is why. We need to understand what patients are expecting and seeking from CAM and how they chose their particular practices. This requires sensitivity to the cultural, social, and ethnic diversity among our patients.

The interest in CAM is an understandable expression of the hopes, concerns, and symptoms experienced by cancer patients. Such interest poses a challenge to oncologists: a challenge not to our scientific credentials or clinical intentions. A challenge to be better doctors — to treat the disease and the patient. The use of complementary health-related practices is an opportunity to discuss the meanings that lie behind these practices, to share further in the experience of illness and well-being, and to focus clinicians on the genuine needs of cancer patients that neither surgery nor radiation nor chemotherapy can satisfy.

—Burstein HJ. J Clin Oncol 2000;18(13) 2501-2504
No Abstract Available

VARIABILITY IN THE QUALITY OF INFORMATION ABOUT CAM

Information about CAM varies widely in its accuracy. Many web sites and publications that seem to be objective actually are sponsored by commercial enterprises that promote and sell the products they report. Misinformation about health issues abounds. In 1999, the United States Federal Trade Commission (FTC) announced that it had identified hundreds of web sites selling bogus cures for cancer and other serious illnesses among the estimated total of approximately 17,000 health-related web sites. It is all but impossible for most patients to distinguish between reputable sources of information and those backed by vested interests. Some promotional materials and books are written by medical doctors and seem to present legitimate information.

—Cassileth B. J Clin Oncol 1999;17(11, Suppl):44-52.
No Abstract Available

DISTINCTION BETWEEN COMPLEMENTARY AND ALTERNATIVE MEDICINE

Complementary therapies, such as massage or relaxation methods, are used adjunctively along with mainstream care for symptom management and to enhance quality of life. Alternative therapies (such as the regimen developed at the Gerson Clinic in Tijuana, laetrile, shark cartilage, or the Di Bella therapy) are active biologically, often invasive, and typically promoted as cancer treatment to be used instead of mainstream therapy. Complementary therapies can be helpful but alternative medicine, because it can create direct physiologic interference or indirect harm by keeping patients from receiving timely care, presents serious problems to both the oncologist and the patient.

—Cassileth et al. Cancer 2001;91(7):1390-1393.
No Abstract Available

POTENTIAL FOR HARM WITH ALTERNATIVE MEDICINE

Alternative therapies are promoted or used as independent treatments in place of surgery, chemotherapy, or radiation. Typically invasive and biologically active, alternative regimens are unproved, expensive, and potentially harmful. They may cause harm directly through biologic activity, or indirectly, when patients postpone mainstream therapies. Examples of alternative therapies in cancer medicine include the metabolic therapies available in Tijuana, Mexico; shark cartilage; high-dose vitamins; and other products and remedies sold over-the-counter in the US and elsewhere. Although research evidence is scanty, it appears that approximately 8% to 10% of cancer patients with diagnoses confirmed by tissue biopsy eschew mainstream therapy and immediately seek alternative care. The vast majority of individuals who seek CAM, however, use complementary rather than alternative therapies. Almost all studies to date of cancer patients and of the general public show that those who seek CAM therapies tend to be female, better educated, of higher socioeconomic status, and younger than those who do not.

—Cassileth B. CA Cancer J Clin 1999;49:353-361.
No Abstract Available

HARMFUL INTERACTIONS OF HERBS WITH MAINSTREAM MEDICAL PROCEDURES

. . . lack of government regulatory authority leaves consumers at the mercy of those who promote unproved remedies, scores of which line grocery store and pharmacy shelves. Many of these over-the-counter products contain harmful ingredients. Herb-drug interactions, only some of which are documented, occur with frequency and are sufficiently problematic to require that patients stop taking herbal remedies prior to surgery (to prevent interactions with anesthetics and anticoagulant effects); before radiation (due to potential for increased photosensitivity); and during courses of chemotherapy (to prevent product-drug interactions).

—Cassileth B. CA Cancer J Clin 1999;49:353-361.
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