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Complementary and Alternative Medicine in Cancer Treatment (PDQ®)
- Questions and Answers About Complementary and Alternative Medicine in Cancer Treatment
- Changes to This Summary (04/11/2013)
- About PDQ
- Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine (see Question 1).
- It is important that the same scientific evaluation that is used to assess conventional approaches be used to evaluate CAM therapies (see Question 4).
- The National Cancer Institute and the National Center for Complementary and Alternative Medicine are sponsoring or cosponsoring various clinical trials (research studies with people) to study CAM therapies for cancer (see Question 6).
- It is important that patients inform all of their health care providers about any therapies they are currently using or considering. This is to help ensure a safe and coordinated course of care (see Question 8).
Questions and Answers About Complementary and Alternative Medicine in Cancer TreatmentWhat is complementary and alternative medicine? Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of different medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. Conventional medicine is medicine that is practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by health professionals who work with them, including physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.This summary answers some frequently asked questions about the use of CAM therapies among the general public and about how CAM therapies are evaluated, and suggests sources for more information.What is integrative medicine?NCCAM defines integrative medicine as treatment that combines conventional medicine with CAM therapies that have been reported to be safe and effective after being studied in patients. In practice, many CAM therapies used in along with conventional medicine have not yet been well tested.Are complementary and alternative therapies widely used?Yes. Many CAM approaches are used by a large percentage of people in the general public and cancer patients.The 2007 National Health Interview Survey reported about 4 out of 10 adults used CAM therapy in the past 12 months, with the most commonly used treatments being natural products and deep breathing exercises. One large survey of cancer survivors reported on the use of complementary therapies. The therapies used most often were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31-84% of children with cancer, both in and outside of clinical trials. CAM therapies have been used in the management of side effects caused by cancer or cancer treatment. How are CAM approaches evaluated?It is important that CAM therapies be evaluated with the same long and careful research process used to evaluate conventional treatments. The National Cancer Institute (NCI) and the Office of Cancer Complementary and Alternative Medicine (OCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer. A listing of these trials is available at the OCCAM Clinical Trials Web page.Conventional cancer treatments have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of many CAM therapies. Research of CAM therapies has been slower for a number of reasons: Time and funding issues.Problems finding institutions and cancer researchers to work with on the studies.Regulatory issues.Some CAM therapies have undergone careful evaluation. A small number of CAM therapies originally meant to be alternative treatments are finding a place in cancer treatment as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or possibly harmful.What is the NCI Best Case Series Program?The NCI Best Case Series Program, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches that warrant NCI-initiated research.Are NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine?NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for patients with cancer. Some of these trials study the effects of complementary approaches used in addition to conventional treatments, while others compare alternative therapies with conventional treatments. Current trials include the following:Effect of Coenzyme Q10 on doxorubicin blood levels in women undergoing treatment of breast cancer (NCT00976131).Effect of high-dose vitamin C on increasing survival in patients with pancreatic cancer (NCT01515046).Acupuncture to prevent dry mouth and improve quality of life in head and neck cancer patients receiving radiation (NCT01266044).Effect of Tai Chi versus structured exercise on physical fitness and stress reduction in cancer survivors (NCT00246818).Acupressure for persistent cancer-related fatigue (NCT01281904).Patients who are interested in taking part in these or any clinical trials should talk with their doctor.Several clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching the following:The NCI’s PDQ Clinical Trials Database, which can be searched by using criteria such as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI’s Cancer Information Service (1–800–4–CANCER [1–800–422–6237]; TTY: 1–800–332–8615).The NCCAM Clinical Trials Web page, which can be searched by the type of treatment or disease. The OCCAM Clinical Trials Web page, which provides links to NCI’s PDQ Clinical Trials Database.The Clinical Trials.Gov Web page, which can be searched by the type of medical condition or intervention.What should patients do when using or considering complementary and alternative therapies?Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. Some resources for this information are provided in Question 9.When considering complementary and alternative therapies, what questions should patients ask their health care providers?What benefits can be expected from this therapy?What are the risks associated with this therapy?Do the known benefits outweigh the risks? What side effects can be expected?Will the therapy interfere with conventional treatment?Is this therapy part of a clinical trial? If so, who is sponsoring the trial?Will the therapy be covered by health insurance? Further information on evaluating CAM therapies and practitioners is available from NCCAM.What federal agencies can provide more information about CAM therapies?Patients, their families, and their health care providers can learn about CAM therapies from the following government agencies and resources:NCCAMNCCAM is the federal government’s lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. The NCCAM Clearinghouse provides information on NCCAM and on CAM, including fact sheets, other publications, and searches of federal databases of scientific and medical literature. Publications include the following: Are You Considering CAM?Selecting a CAM PractitionerPaying for CAM TreatmentThe Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.NCCAM ClearinghousePost Office Box 7923Gaithersburg, MD 20898–7923Toll-free in the United States: 1–888–644–6226International: 301–519–3153Callers with TTY equipment: 1–866–464–3615Fax-on-Demand service: 1–888–644–6226E-mail: firstname.lastname@example.orgWeb site: http://nccam.nih.govNCIOCCAMNCI's OCCAM coordinates the activities of NCI in the area of complementary and alternative medicine. OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public on the NCI Web site.NCI Cancer Information ServiceU.S. residents may call the NCI Cancer Information Service toll free at 1–800–4–CANCER (1–800–422–6237) Monday through Friday from 8:00 AM to 8:00 PM Eastern Time. A trained Cancer Information Specialist is available to answer your questions.PDQNCI’s PDQ, a comprehensive cancer information database, contains peer-reviewed summaries of the latest information about the use of CAM in the treatment of cancer. Each summary contains background information about the specific treatment, a brief history of its development, information about relevant research studies, and a glossary of scientific and medical terms. CAM summaries can be found on NCI's Web site.U.S. Food and Drug Administration (FDA)The FDA regulates drugs and medical devices to ensure that they are safe and effective. This agency provides a number of publications for consumers, including information about dietary supplements.U.S. Food and Drug Administration5600 Fishers LaneRockville, MD 20857Telephone: 1–888–463–6332 (toll free)Web site: http://www.fda.govFDA’s Dietary Supplements Web page: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm153239.htmFederal Trade Commission (FTC)The FTC enforces consumer protection laws and offers publications to guide consumers. The FTC also collects information about fraudulent claims.Consumer Response CenterFederal Trade CommissionCRC–240Washington, DC 20580Telephone: 1–877–FTC–HELP (1–877–382–4357) (toll free)Callers with TTY equipment: 202–326–2502Web site: http://www.ftc.govCAM on PubMedCAM on PubMed, a database accessible via the Internet, was developed jointly by NCCAM and the NIH National Library of Medicine (NLM). It contains bibliographic citations (from 1966 to the present) to articles on CAM published in scientifically based, peer-reviewed journals. These citations are a subset of NLM's PubMed system, which contains more than 11 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to many publisher Web sites, which may offer the full text of articles.1White JD: Complementary, alternative, and unproven methods of cancer treatment. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 3147-57.2Barnes PM, Bloom B, Nahin RL: Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report (12): 1-23, 2009.3Gansler T, Kaw C, Crammer C, et al.: A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer 113 (5): 1048-57, 2008.4Kelly KM: Complementary and alternative medical therapies for children with cancer. Eur J Cancer 40 (14): 2041-6, 2004.5NIH Consensus Conference. Acupuncture. JAMA 280 (17): 1518-24, 1998.
Changes to This Summary (04/11/2013)
Editorial changes were made to this summary.
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
This information was last updated on 2013-04-11