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. There has also been greater use of alternative treatment modalities, leading to concerns that the use of existing effective therapies may be delayed or abandoned, or that unfavorable drug-drug interactions may occur.

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 for 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.

—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.

—Burstein HJ. J Clin Oncol 2000;18(13):2501-2504
Abstract

POTENTIAL FOR HARM WITH ALTERNATIVE MEDICINE

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
Abstract .

REASONS AND EXPECTATIONS FOR CAM USE Reason or expectation Patients reporting (%) Expected improved quality of life 76.7% Used for desire to feel hopeful 73.0% Expected boosted immune system 71.1% Expected prolonged life 62.5% Used because belief that therapies are nontoxic 48.9% Expected symptom relief 44.0% Used to have more control in decisions about medical care 43.8% Expected cure of disease 37.5% Richardson MA et al. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 2000;18(13):2505-2514. Abstract   MD ANDERSON STUDY OF PREVALENCE AND PREDICTORS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE USE IN CANCER PATIENTS (N=453) Proportion of Patients Who Used CAM Type of CAM Discussed CAM with physician (%) Combined CAM with conventional therapy (%) CAM overall 61.8 88.0 CAM overall excluding spiritual/psychotherapy 60.7 75.2 Richardson MA et al. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 2000;18:2505-14. Abstract   SURGEONS What do you consider to be common uses of alternative or complementary medicine (i.e. nutrition/ diet, herbs, massage) by your patients? Excercise 53% Vitamins/Minerals/Supplements 46% Diet 43% Soy 25% Support Groups 25% Herbs 20% About what percentage of your breast cancer patients are accessing information about their treatment from the Internet? Median 50% About what percentage of your patients bring the information to your attention? Median 25%

Burstein HJ et al. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 1999;340:1733-9. Abstract

Cassileth BR. Evaluating complementary and alternative therapies for cancer patients. CA Cancer J Clin 1999;49:362-75. Full-Text

Cassileth BR et al. Alternative medicine use worldwide: The International Union Against Cancer survey. Cancer 2001;91:1390-3. Abstract

Jacobson JS et al. Research on complementary/alternative medicine for patients with breast cancer: A review of the biomedical literature. J Clin Oncol 2000;18:668-83. Abstract

Lee MM et al. Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 2000;92:42-7. Abstract

Paltiel O et al. Determinants of the use of complementary therapies by patients with cancer. J Clin Oncol 2001;19:2439-48. Abstract

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