Complementary - Integrative Medicine and Cancer Care
Dr. Barrie Cassileth PhD Chief of Integrative Medicine - Memorial Sloan-Kettering Cancer Center. Medically reviewed by C.H. Weaver M.D. 4/2020
Complementary medicine refers to a broad range of health practices that may be used in addition to conventional medical care. These treatments do not replace conventional cancer care and are not intended to treat cancer, but research suggests that certain types of complementary therapies may help manage symptoms and side effects and improve a person’s overall sense of well-being.
Complementary medicine is often referred to in combination with alternative medicine as “complementary and alternative medicine” (also known as CAM). Alternative medicine refers to treatments that are used in place of conventional medical care. Since alternative treatments have not been shown to be effective for cancer treatment, this overview focuses on complementary medicine.
Integrative medicine refers to the coordinated delivery of both conventional and complementary medical treatment. Integrative medicine generally focuses on complementary therapies that have at least some high-quality evidence to support their efficacy and safety.
If you are interested in adding complementary therapy to your cancer treatment, talk with your cancer treatment team. They may be able to refer you to providers who have experience working with people with cancer. It’s also important to talk with your treatment team about the safety of the complementary therapies that you are considering. Some complementary therapies—such as certain dietary supplements and botanicals—can interfere with conventional cancer treatment and are not advised for people with cancer.
Conventional medicine is often referred to as Western or mainstream medicine, and is technically known as allopathic medicine. Examples of conventional cancer treatment include surgery, chemotherapy, radiation, and biologic therapies. (1,2)
Be Cautious - Complementary Medicine Can Decrease Survival
According to a study published in JAMA Oncology by doctors from Yale Cancer Center people who received complementary therapy for curable cancers were more likely to refuse at least one component of their conventional cancer treatment and were more likely to die as a result of that decision. (3) This is not the first study to suggest the use of complementary medicines may have an adverse impact on survival. (6)
There is increasing interest by patients and families in pursuing alternative medicine as opposed to conventional cancer treatment. Studies suggest that the use of alternative medicines is increasing and that many patients do not share this information with their physician. (4) One report found that as many as 60% of cancer patients are using complimentary medicine and not sharing this information with their treating physician. (5)
The Yale study found that
- Patients who received complementary medicine in addition to conventional cancer treatments had a greater risk of dying.
- These patients were more likely to refuse other aspects of recommended care like chemotherapy, surgery, radiation and/or hormone therapy.
Complementary Medicines are an important component of overall cancer care and can be successfully integrated into an overall care plan. Patients however should not use these treatments in stead of established effective therapies and should always work in concert with their treatment team to obtain the best results.
Complementary Therapies and Cancer
There are several common threads shared by the diverse therapies classified as complementary. Complementary medicine is generally considered holistic, looking at the physical, mental, emotional and spiritual components that make up a whole person. Patients may use complementary therapies to promote wellness, manage symptoms, and augment treatment of a condition.
Supportive Care Strategies for:
Complementary & Integrative Medicine:
- Complementary Therapies & What They Can Do For You
- Complementary Medicine
- Creative Therapies
- Art Therapy
- Music Therapy
- Humor Therapy
- Dignity Therapy
- Healing Spaces
- Cancer Retreats
- Imagery and Visualization
- Naturopathic Medicine
- Massage Therapy
Types of Complementary Therapy
Whole Medical Systems: Whole medical systems involve complete systems of theory and practice that have evolved independent of and often prior to the conventional medical approach. Such systems include traditional systems of medicine practiced by indigenous people worldwide for thousands of years. Some of these well-known medical systems are traditional Chinese medicine and Ayurveda. Other alternative medical systems have developed more recently, such as homeopathy.
Natural Products: These products include herbs, dietary supplements, and probiotics. If you are thinking about using one of these products, be sure to discuss it with your physician first. Some products have well-documented health risks. Products may also be dangerous when used in combination with other medications, or in people with certain health problems.
Energy Therapies: Energy therapies are divided into two categories, those that originate from within the body (biofields) and those that are generated by sources outside of the body (external energy sources).
Biofield therapies are based on the theory that energy fields are generated within, and emanate from, the body and that disruption of a biofield results in disease. In some therapies, an individual performs certain postures to affect their biofields (e.g., Qi Gong, Tai Chi, Yoga). Some therapies attempt to manipulate biofields through touching the body (as in acupressure), while others move the practitioner’s hands through the biofield without touching the patient’s body to clear energetic imbalances (e.g., Reiki, Therapeutic Touch). Biofields may also be affected by substances such as flower remedies or crystals and stones, which may interact with the biofield to restore energetic harmony/balance. Very little research exists on biofields and conventional medicine has yet to verify their existence.
External energy sources include pulsed electrical fields, magnetic fields, radiowaves and direct or alternating current fields which may be used to treat cancer or manage symptoms, such as pain. Therapies using external energy sources are sometimes referred to as bioelectromagnetic-based therapies.
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Manipulative and Body-Based Methods: This category includes methods that are based on manipulation of bone, soft tissues or organs by a practitioner or by the patient. It is based upon the theory that restoring skeletal, neuromuscular, soft tissue or organs to their correct location within the body harmonizes the entire system. Practitioners of these methods may believe that a disturbance in one part of the body creates disruptions that can manifest as disease or pain elsewhere in the body. Chiropractors, osteopaths and massage therapists are examples of practitioners employing these methods. Acupuncture is also considered to be a manipulative and body-based method.
Mind-Body Interventions: Mind-body interventions are designed to utilize the mind’s ability to affect bodily symptoms and function. Many mind-body interventions have been extensively studied, including cognitive-behavioral therapy, psychotherapy and patient education. As a result of such research, these therapies have been adopted by conventional medicine and are no longer considered CAM therapies. However, there are numerous other therapies utilizing mind-body interventions that remain to be studied. Examples of such therapies include meditation, dance, music, art therapy, guided imagery, yoga, acupuncture, and biofeedback.
What Complementary Therapies Can Do for You
Complementary therapies empower you, the patient. After being diagnosed with cancer, you might feel like you are ceding control to a team of experts—your medical oncologist, radiation oncologist, and surgeon, not to mention their nurses and technicians. Together all of these experts can give you the best-quality care available for your condition, but it’s not uncommon to feel lost in such a system.
Integrative medicine puts the ball back in your court. It offers a broad array of therapies and lifestyle choices that not only make a real difference for your health and happiness but also give you back a sense and reality of control and confidence.
There are many things you can do to maintain the best possible physical and emotional health throughout your cancer treatment and beyond. You can eat better, be physically active, and manage your stress through mind-body techniques. Acupuncture treatment and massage therapy will help minimize unwanted symptoms of chemotherapy or radiation. For example, studies suggest that acupuncture can be very helpful for reducing nausea and vomiting, as well as hot flashes that may arise if you are prescribed hormonal therapy. Acupuncture is successful at promoting relaxation, reducing stress, and diminishing pain, as well.
Most major cancer centers across the country, and many community hospitals, now have integrative medicine departments that offer some or all of these therapies, on both an inpatient and an outpatient basis. Talk to your oncologist but also consider speaking with a physician who specializes in integrative medicine or an expert in integrative medicine who specializes in working with cancer patients. They can help guide you to the best complementary therapies for particular problems and help you develop a comprehensive treatment plan that achieves the greatest synergy between the mainstream and complementary domains, giving you the best chance of beating cancer while helping you live in as much comfort as possible through treatment and thereafter.
Modalities in the integrative medicine realm can be categorized in different ways. Some involve long-term lifestyle changes; others are treatments you can receive from a practitioner once a week or so. Still others you can learn and then practice entirely on your own in the comfort of your home.
If you are considering specific complementary therapies, it is important to consider how researchers determine if a particular therapy works—or doesn’t work. It is research results that provide confidence that a therapy may provide the desired result.
What Integrative Medicine Is… and Is Not
Cancer patients and their loved ones can benefit from a clear understanding of what integrative medicine offers—and of the dangers of alternative therapies.
Integrative medicine takes advantage of complementary therapies such as acupuncture, massage, meditation, yoga, guided imagery, and self-hypnosis. The field especially emphasizes the crucial importance of good nutrition and physical activity. Always along with—not instead of—conventional cancer care, integrative medicine incorporates these and other modalities to manage symptoms that may occur during cancer treatment and remain after its completion.
Integrative therapies reduce both short- and long-term side effects, such as pain and anxiety. They can relieve stress, promote general well-being, and, in some cases, reduce the risk of cancer recurrence. According to the Consortium of Academic Health Centers for Integrative Medicine, there are yet other integrative medicine benefits: it “reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.”
The Important Difference between Alternative and Complementary Medicine
In the realm of integrative medicine or integrative oncology, terminology can be very confusing. Alternative and complementary are sometimes used synonymously, and the acronym CAM (complementary and alternative medicine) perpetuates the problem. Here is a better set of terms used by integrative medicine specialists and increasingly by others:
- Alternative medicine is understood to mean treatments promoted for use instead of conventional cancer therapy. Alternative medicine encompasses a broad array of unconventional treatment modalities that are generally either unproven or were disproved in scientific studies.
- Complementary therapies are treatments used in conjunction with conventional care. They are rational and scientifically validated for symptom control along with mainstream cancer care.
Some modalities that have an appropriate complementary usage may be considered by some for use in treating cancer instead, making that use “alternative” instead of complementary. An example is the use of acupuncture for symptom control (a very helpful complementary therapy); but the use of acupuncture to treat cancer would be a pointless “alternative” treatment. Alternative techniques are to be avoided. They can be dangerous as well as useless.
Acupuncture, massage therapy, and music therapy, among other modalities, have been shown to be safe and effective as complementary treatments for managing pain, nausea, stress, and many other symptoms and for supporting overall patient well-being. Their growing use in mainstream cancer settings is known as integrative oncology.
A Critical Distinction
Be wary of any claim that a non-mainstream technique (something other than surgery, chemotherapy, or radiation therapy) can treat or cure cancer. Be wary even when such approaches use the term integrative.
Whether such claims are products of wishful thinking or malicious scams, they are not supported by scientific research. Remember that complementary (also called integrative) therapies, by definition, must be used in conjunction with or following the conclusion of—not instead of—conventional care. Complementary therapies, helpful as they can be, are not in themselves curative. When used along with mainstream care, however, they can help you weather both the disease and any negative side effects of treatment.
Knowledge Is Power—but Consider the Source
An enormous amount of information about integrative medicine can be found in printed sources and online. But again, a word of caution: Some of this information is high quality and scientifically validated, and some is not. Some is downright ugly, as there are many scam artists out there promoting bogus remedies and cures.
Currently, a simple Google search for “alternative cancer” produces close to 62 million hits! One site that ranks highly in that search and should be avoided is Alternative-Cancer.net, which is representative of the numerous sites that provide and/or sell “advice” on a range of therapies purported to cure cancer without mainstream treatment. On the other hand, there are useful sites that debunk false information, such as Quackwatch.org, and that provide good information on complementary treatments, their risks, and their benefits.
The problem of quackery has been recorded since the seventeenth century. Some quacks are true charlatans with purely financial motives, whereas others are believers in what they preach. Both, however, promote unproven or disproved alternative therapies as cures for disease. And, unfortunately, there is no shortage of patients willing to embark on these questionable and often very expensive treatment plans. Desperate patients and their loved ones are inclined to believe in miracles—particularly when facing serious or untreatable illnesses.
The truth is that unproven approaches are dangerous to patients. Even when the therapy itself does not harm, people too often choose to shun conventional treatment entirely and replace it with an alternative treatment that does nothing to diminish the disease. Public education can help, along with knowledgeable doctors who are familiar enough with alternative approaches to successfully guide patients away from them.
When used correctly, complementary therapies can provide relief of side effects caused by cancer treatments or by the cancer itself both during and following treatment.
What Is Proper Research?
In proper research, following promising clinical or laboratory results, a new therapy is pilot-tested to determine the best dosage and other important preliminary information. If the new therapy appears safe and effective, a larger, more definitive clinical trial is conducted. This trial will be “randomized,” which means that patients will be randomly assigned to receive or not receive the therapy during the trial’s duration. Determined by an electronic version of a coin-toss random allocation, patients will belong either to a group receiving the new treatment or a group receiving the standard treatment for that specific cancer diagnosis.
The two or more groups of subjects are then followed in exactly the same way, receiving the same tests, doctor visits, and the like. Patients and their caregivers do not know to which group they were randomly assigned. Proper randomization balances known and unknown factors that might influence results, helping ensure that the results are valid and not influenced by patient perceptions. Randomized clinical trials are lengthy and expensive, but they have produced the major advances in cancer treatment that led to the more than 67 percent survival rate of US patients across all cancers.
Complementary treatments offer cancer patients many important advantages. They range from extended survival (exercise) to relieving stress, anxiety, and other symptoms (acupuncture, mind-body therapies). The several types of complementary therapies that have been studied and found to be beneficial for many cancer patients include diet, being savvy about supplements, physical fitness, acupuncture, mind-body therapies, massage therapies, and creative therapies.
Safety and Regulation of CAM
All medical treatments entail some degree of risk and CAM therapies are no different. CAM therapies can be divided into two groups when examining safety concerns and regulatory issues. The first group contains products that a patient typically uses either internally or externally. These CAM therapies, such as Echinacea capsules or colloidal silver salve, are regulated as dietary supplements in the United States. The second group of CAM therapies consists of therapeutic processes a patient undergoes with a practitioner. Examples of these CAM therapies include reiki, massage and chiropractic medicine. When therapeutic processes are regulated, it is usually by state agencies or licensing boards. There are some practitioners, such as naturopaths, which utilize dietary supplements in addition to therapeutic processes and are affected by both categories.
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Regulations - Most herbs, vitamins, minerals, amino acids and other “natural” substances sold over the counter are designated as “dietary supplements” in the United States (the main exception being homeopathic drugs which are regulated separately; see Homeopathy for additional information). These products are considered dietary supplements because their use is intended to “supplement” a person’s diet; because of this distinction, they are regulated as food and not as drugs.The Dietary Supplement Health and Education Act (DSHEA) passed by the United States Congress in 1994 formally defined “dietary supplements”, outlined guidelines for literature displayed where supplements are sold, established a new framework for safety, required ingredient and nutrition labeling, provided for “use of” claims and nutritional support statements and granted the FDA authority to establish good manufacturing practice (GMP) regulations.
The law also required the formation of an executive level Commission on Dietary Supplement Labels and led to the establishment of the Office of Dietary Supplements within the National Institutes of Health. According to the this law, the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed, while the FDA is responsible for taking action against a product if it appears unsafe after introduction to the market. Manufacturers do not usually need to get FDA approval prior to selling a dietary supplement nor do they need to register with the FDA. The FDA only reviews safety and efficacy data prior to allowing a new product to be sold when it contains a new dietary ingredient (i.e., those not marketed in the United States prior to October 15, 1994). However, manufacturers must ensure that their statements are not misleading and have sufficient evidence to substantiate their product claims.
A product is considered unsafe when it appears to cause acute or chronic toxicity, has interactions with medications or is contaminated with pesticides, heavy metals or prescription drugs. The FDA may issue a warning or recall for such supplements.The FDA does not monitor manufacturing practices. It is the responsibility of the manufacturer to maintain safe production procedures in accordance with GMP and ensure that the label information is accurate. Several concerns have arisen from this lack of regulation. Some herbal products, particularly those manufactured in China, may contain pesticides, heavy metals, prescription medications and other herbs that are not listed on the products’ labels. In addition, research comparing several different brands of DHEA and ginseng products have found labeling discrepancies. One study found that few dietary supplement labels correctly identified the amount of DHEA in the supplement, ranging from no or trace amounts of DHEA to 150% of the labeled amount. Another study noted that many ginseng supplements contain the incorrect species of ginseng (e.g., American ginseng rather than Siberian ginseng). To address these concerns, the National Center for Complementary and Alternative Medicine (NCCAM) has started funding Centers for Dietary Supplement Research. Four centers will conduct research on dietary supplements and investigate manufacturing procedures that enable production of purer, more standardized products.
Many people believe that dietary supplements are safe because they are sold in health food stores and are more ”natural” than conventional pharmaceuticals. However, this is not necessarily the case. Many pharmaceutical drugs were originally derived from natural, plant sources. Hence, the active ingredients in plant or herbal sources are potentially powerful medicines that may have drug-like effects in therapeutic doses.
Many natural substances such as the herb Belladonna or certain mushrooms are natural and yet poisonous enough to cause acute toxicity when eaten. Even dietary supplements that appear to be relatively safe for short-term use may be dangerous when used for extended periods of time (i.e., chronic toxicity). Each individual may have different responses to dietary supplements. Known or unknown allergies, pre-existing conditions, diseases or organ dysfunctions may make it dangerous to take certain products (e.g., cat’s claw and autoimmune diseases).
Another concern is that a patient may be taking medications (prescription or over-the-counter) that have harmful interactions with certain natural products (e.g., Gingko biloba and warafin). As with many prescription and over-the-counter medications, many dietary supplements are not safe for pregnant or breastfeeding women or young children.Little research is available on the safety of dietary supplements. Case reports, rather than clinical studies, are usually all that are available. Physicians use these case reports, combined with inferences from folk traditions and our understanding of how the dietary supplement may work, to develop a picture of the relative safety of a dietary supplement and its contraindications. Contraindications are circumstances, either illnesses, medications, etc., in which the dietary supplement should not be taken. Some contraindications are rooted in evidence, while others are speculative.If a product demonstrates dangerous side effects or interactions, the FDA will usually issue a warning or recall.
CAM Therapies Involving Therapeutic Processes
Regulations - Practitioner certification, accreditation or licensing is generally regulated by states. Many states have regulatory agencies or licensing boards for practitioners of specific types of CAM (e.g., chiropractors, massage therapists, counselors). However, most CAM practitioners are not regulated at the state level at this time. This is changing as CAM therapies gain increasing popularity and standards are sought to ensure practitioners’ competency.Even without formal state licensing or accreditation, many practitioners have graduated from accredited institutions (e.g., chiropractic, naturopathic, or acupuncture schools) or are members of organizations that practice self-regulation (i.e., must meet certain training requirements).
Safety - The safety of CAM therapies involving therapeutic processes depends on the CAM therapy itself and on the individual CAM practitioner. Little research has been done on the safety of most CAM therapies. Nonetheless, it is advisable for a patient to examine the scientific evidence available with regard to safety of a specific CAM therapy. An oncologist or other health care professional may be able to help interpret any scientific studies or case reports that are available.When considering a prospective practitioner, it is important to consider their knowledge, skill and experience to minimize risk. For more information on choosing a CAM practitioner, please refer to the sections.
More Information on CAM and Cancer Care:
Q & A with Barrie R. Cassileth, PhD
Author, Survivorship: Living Well during and after Cancer
Laurance S. Rockefeller Chair and Chief of Integrative Medicine Memorial Sloan-Kettering Cancer Center
Q. How did you initially become interested in the field of integrative medicine?
A. Many years ago I spent a year working full-time with patients and family members in the adult leukemia unit at the University of Pennsylvania Cancer Center in Philadelphia. The original purpose was to observe patients for my doctoral dissertation, but my time there wound up profoundly influencing my career path. My doctoral thesis became my first book, The Cancer Patient: Social and Medical Aspects of Care (Williams & Wilkins, 1979). I believe this was the first medical book to deal with the “social” aspects of cancer care. It struck me that, although expert medical care was crucial, it was not sufficient; an emphasis on the emotional and day-to-day life-changing components of cancer, for family members as well as patients, were equally important and necessary to address.
Q. What does your current role as Laurance S. Rockefeller chair and chief of the Integrative Medicine Department at Memorial Sloan-Kettering Cancer Center involve?
A. In my current role, I have developed and implemented the three main pillars of the integrative medicine program—the same pillars present in any academic medicine program: clinical care, research, and education.
Clinically, we offer inpatient and outpatient integrative therapies that address symptoms caused primarily by lifesaving, effective mainstream cancer treatments, including acupuncture treatment, massage, mind-body therapies, exercise, yoga, music therapy, and dietary supplementation and nutritional counseling. We study many of these interventions to document their ability to control particular side-effects.
Education includes many lectures to patient and professional oncology groups, assisting other cancer centers internationally to develop integrative programs, and hosting Internet courses for specific professional groups, such as physicians, yoga instructors, and other providers of integrative therapies. We have also developed a free website, mskcc.org/aboutherbs, which contains data-based information about herbs and also about dietary supplements, nutritional issues, useful integrative therapies, and bogus claims, which has been immensely popular.
Q. You have contributed substantially to the literature related to integrative medicine—both for medical professionals and patients and families; what was your goal in your latest work, Survivorship**********?**
A. My goal was twofold: first, to provide information to optimize quick and correct cancer diagnoses and successful treatment; second, to ensure that patients and family members know about integrative (or “complementary”) therapies, as these control the physical and emotional problems of cancer and its treatments.
Q. You describe yourself as “a staunch opponent of cancer quackery.” How do you define quackery as it relates to integrative medicine, and what should patients know about identifying reputable sources of information and treatment?
A. Cancer quackery is a huge problem in the United States and other countries and can be generally defined as the promotion and the sale of useless “therapies” to treat cancer. Often called “alternative” cancer treatments, these are promoted as viable treatments or cures, typically sold as literal alternatives to mainstream cancer care. But they do not work. The fact is that there are no viable alternatives to mainstream cancer care. When patients elect to try an alternative therapy and then see their cancer progress due to the ineffectiveness of the therapy, the cost is measured not only in dollars but also in time wasted that could have potentially been spent undergoing successful treatment.
Q. What continues to inspire you in your work in the field of integrative medicine?
A. I am inspired on many fronts: by patients and their family members who succeed in getting prompt and specialized care and who help others, serving as eloquent examples in their journey; by scientists, researchers, and oncology professionals who work so very hard to advance the science and provide care; and the increasing evidence-based documentation of the effectiveness of integrative medicine.
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- National Center for Complementary and Alternative Medicine: What is Complementary and Alternative Medicine? Last updated May 2018.
- National Center for Complementary and Alternative Medicine: Cancer and Complementary Health Practices. Last updated March 2018.
- Using only alternative medicine for cancer linked to lower survival rate
- Von Gruenigen VE, White LJ, Kirven MS, et al. A comparison of complementary and alternative medicine use by gynecology and gynecologic oncology patients. International Journal of Gynecological Cancer .2001;11:205-9
Excerpted with permission from Survivorship: Living Well during and after Cancer *(Spry, 2014; $16.95), by Barrie Cassileth, PhD. © Spry Publishing 2014.