Complementary and Alternative Medicine

Source: Susan G. Komen for the Cure

INTEGRATIVE AND COMPLIMENTARY THERAPIES

Many people use complementary therapies during and after their cancer care. Complementary therapies, also called integrative therapies, include things like acupuncture, herbs and prayer. Complementary therapies are used in addition to standard treatments like surgery, chemotherapy and hormone therapy. They offer people the chance to try therapies outside of their standard medical care to improve quality of life and to relieve treatment- and disease-related symptoms. Others may turn to alternative therapies, which are used instead of standard treatment. This approach is not recommended.

This section of Understanding Breast Cancer provides an overview of the complementary and alternative medicine (CAM) field as well as detailed information on some popular complementary therapies. 
 


Complementary Therapies
To see therapies grouped by category, click here

Issues in CAM

Integrative and Complementary Therapies Introduction

What are complementary and alternative medical (CAM) therapies? The National Center for Complementary and Alternative Medicine at the National Institutes of Health defines them as:
"a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" [1].
What does this mean exactly? It means that CAM therapies as a group are not generally covered in great detail in Western medical school curricula. And they have not typically been recommended as part of most medical care.

Complementary therapies vs. Alternative therapies

Though they’re often lumped together, it’s important to understand the difference between complementary therapies and alternative therapies. Complementary therapies are used in addition to standard treatments like surgery, chemotherapy and hormone therapy. Alternative therapies are used instead of such treatment.
While some CAM therapies have shown benefit when used with standard treatment, no one should ever use CAM in place of standard treatment. Surgery, radiation, chemotherapy and hormone therapy have all been proven to increase survival in persons with breast cancer. To use alternative therapies instead of these proven treatments is to literally put your life at risk.

Scientific studies on CAM

CAM is a broad field that includes many therapies. And, the body of scientific evidence on such therapies is large and growing. However, few CAM therapies have been studied with the same degree of scientific rigor as standard medicine. While a number of complementary therapies have been shown to offer some benefit and are likely safe to use, others should be avoided. Some CAM therapies have been shown to be ineffective or unsafe. Others, although safe, lack enough evidence to draw solid conclusions.
Despite the hopes of many, CAM does not offer “magic bullets” to cure cancer. Media articles, advertising and labeling make it easy to think otherwise. The current scientific evidence supporting CAM is stronger for reducing cancer-related symptoms (like nausea) than for treating the disease itself

Complementary therapies/Integrative therapies

CAM is a broad field that includes many therapies. And, the body of scientific evidence on such therapies is large and growing. However, few CAM therapies have been studied with the same degree of scientific rigor as standard medicine. While a number of complementary therapies have been shown to offer some benefit and are likely safe to use, others should be avoided. Some CAM therapies have been shown to be ineffective or unsafe. Others, although safe, lack enough evidence to draw solid conclusions.

Major Categories of Complementary Therapies

Just like different types of food can be placed into specific categories (e.g., fruits, vegetables, grains), complementary therapies can be grouped into categories. These categories can be useful to describe how a therapy works or where it was first used. It can also provide a common language, which can help people and their health care providers share ideas about complementary therapy use (more).
One of the most popular ways to group complementary therapies comes from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. The NCCAM identifies four major categories of complementary therapies [1]. In addition, there are whole medical systems (such as traditional Chinese medicine, homeopathic medicine and Ayurveda) that use many therapies from these four categories.

The four major categories of complementary therapies are listed below.

  • Mind-body medicines use techniques to help the mind affect body functions and try to improve symptoms of disease and/or treatment (examples include meditation, prayer and psychotherapy).
  • Biologically based practices use natural products, like vitamins and herbs, to try to treat a variety of conditions (examples include black cohosh, melatonin and vitamins).
  • Manipulative and body-based practices use movement and manipulation of the body to help promote health and ease pain and other problems (examples include chiropractic manipulation and massage therapy).
  • Energy medicines use external electromagnetic fields or the body’s assumed energy field to promote health to try to lessen symptoms of disease and/or treatment (examples include acupuncture, Reiki, qi gong and therapeutic touch).

To see the list of therapies discussed in this chapter broken down into these categories, click here.

Why Do People Use Complementary Therapies

Many people turn to complementary therapies for a sense of hope and control [19]. Others feel that complementary therapies, combined with standard treatment, simply help [5]. People try complementary therapies to:

  • Reduce physical symptoms and side effects of disease and/or treatment
  • Reduce emotional distress
  • Complement standard care with self-care
  • Gain a sense of empowerment and action
  • Improve positive mental outlook
  • Increase quality of life
  • Boost immune system

For many people, culture can also play an important role. People from different cultures may choose complementary therapies simply because such therapies are part of the standard care system in their home countries. In India, Ayurveda is practiced in the national health system. In China, acupuncture, Tai Chi and qi gong are available alongside conventional Western therapies in many hospitals [5]. For people raised in these health systems, seeking out complementary therapies is often just a natural part of seeking care.

Whatever draws people to complementary therapies, it’s important such therapies aren’t used instead of, or even apart from, standard care. Any decisions about CAM use should be made jointly with a health care provider. Talking about CAM with a health care provider helps ensure that all the risks and benefits to your health are carefully considered.
 Updated 03/11/09

Working With Health Care Providers: Shared Decision-Making

An important part of quality health care is shared decision-making between you and your health care provider. In shared decision-making, your provider shares information about your diagnostic tests and treatments and together you make decisions that best fit with your preferences, needs and values.
 Shared decision-making is also an important part of care in CAM, especially for people living with cancer. Alternative therapies (those used instead of standard medical care) are not recommended. While some complementary therapies can be well integrated into standard care, others have dangerous side effects. Some interfere with the effectiveness of chemotherapy and radiation and some make surgery more dangerous and slow recovery. Including your health care provider in decision-making about complementary therapies can help avoid such problems. Unfortunately, many people who use these therapies don’t share this information with their health care providers and this may cause harm [8,20].

Talking with a health care provider can be hard for some people when they want to try something in addition to the care their health care team is giving. However, you should never hesitate to bring up issues that can impact your health. Your well-being is your health care provider’s primary concern. Knowing what additional therapies you are taking (or thinking of taking) is part of giving good care. In fact, the Society for Integrative Oncology’s practice guidelines for health care providers lists asking people about their CAM use as its first recommendation [3]. Working together, you and your health care provider can make decisions about complementary therapies that offer potential benefits without compromising your health.

Talking with Health Care Providers About Complementary Therapies

 

Don’t be shy. Be open with your health care provider and share any thoughts, interests and concerns about complementary therapies.
Make a list. Before your office visit, write down the things you want to talk with your health care provider about and do your best to get through them all before you leave. This is a great tip for any office visit, not just those where you want to talk about complementary therapies.
Be specific about each therapy. For supplements, make a note of the name, the manufacturer and how much of the supplement you’re thinking about taking (or bring the supplements with you to your provider visit). For other types of therapies, make a note of the exact therapy, who (if anyone) will be providing it and how often you’d like to use it.
Keep a symptom diary. When you start a therapy, keep a daily diary of any symptoms (or relief from symptoms) that you’re feeling.
Discuss your use of complementary therapies at each office visit: Use your symptom diary to talk about how you’ve been feeling while using the therapy.


Safety and CAM

Safety is a main concern when it comes to any type of therapy—whether standard or complementary. However, unlike conventional medication, many complementary therapies are not regulated as tightly by the federal government and may not have the same quality controls.

Developing Safety Data

One reason behind many of the safety concerns with CAM is the lack of good scientific evidence on the safety of many therapies. This can make it hard to know which therapies--and at what doses and frequencies of use--are likely to be safe and effective to use and which may be harmful or ineffective.
Any complementary therapy should be approached with caution. While a few therapies have a good record of safety (like acupuncture and massage), some are known to be unsafe (like laetrile, also known as amygdalin) and others are simply unknowns. And even those therapies generally considered safe may not be safe for everyone—such as people undergoing certain cancer treatments or those who have underlying medical conditions, like malnutrition or blood clotting problems.

Potential for Misuse and Harmful Interactions

Any complementary therapy should be approached with caution. While a few therapies have good records of safety (like acupuncture and massage), some are known to be unsafe (like laetrile, also known as amygdalin) and others are simply unknown. Even therapies generally considered safe may not be safe for everyone. Some therapies with good safety records can be harmful to people undergoing certain cancer treatments or those who have underlying medical conditions, like malnutrition or blood clotting problems.
Before using any complementary therapy, you should check with your health care provider. Your provider can help you avoid using a therapy or a dose of a therapy that may be harmful to you. Complementary therapies can interact badly with your standard treatments. Some herbs and supplements, such as black cohosh, may interfere with chemotherapy drugs, other medications used in cancer treatment or radiation therapy [2,21,22]. Some herb therapies, such as garlic and ginkgo supplements, can also cause excessive bleeding and other complications in a person having surgery [2,23]. Moreover, some therapies that may be safe at lower dosages are dangerous in higher amounts. Talking with your health care provider about a complementary therapy you are thinking of using, can help you avoid a harmful interaction with your medical treatments.
Along with talking with your health care provider, you can do your own research. Besides the therapies described in detail in Breast Facts section, the National Center for Complementary and Alternative Medicine also has detailed information on many therapies. A good resource to search for scientific articles on CAM is the National Library of Medicine’s PubMed website.

“Natural” vs. “Safe”

Although the idea of "natural" products is very appealing, it's important to not lose sight that "natural" does not necessarily mean "safe"—think about poison ivy, poisonous mushrooms and rattlesnakes. While the Food and Drug Administration (FDA) currently has some oversight on dietary supplements, it regulates them much less stringently than conventional drugs. If it has evidence that something is dangerous, the government can pull the food or supplement from the market or issue a warning. However, it doesn't require stringent evidence for safety and effectiveness of supplements, like it does for medications, before they can be sold in stores in the United States. To see if any safety alerts have been issued on a product, visit the FDA or Federal Trade Commission (FTC) Web sites. Again, before using any complementary therapy, do your research and check with your health care providers.

Wild Claims

The Internet, supermarket aisles and late night infomercials are filled with products that claim to do just about everything. More often than not, this is a sign that a product is not effective and, more seriously, could be unsafe. If a complementary therapy is said to cure cancer, do your research. This type of claim is a sign that a product or therapy is a scam. There is no one treatment for all types of cancer, or even all types of breast cancer. See what the scientific evidence actually has to say about it. Your health care provider is a good resource for this information. If you suspect that a product or therapy is making a false claim that it prevents or cures cancer, check the FDA’s Fake Cancer Cures website for any consumer warnings. For more information on spotting or reporting false claims, visit the FTC website.

Unknown Contents

With herbs and other dietary supplements, there’s little guarantee that what is listed on the label of a bottle is what’s actually inside the bottle. This is because the manufacture, distribution and sale of supplements are much less regulated than with conventional drugs. When choosing supplements, go with known, reputable manufacturers. This may increase the likelihood that the supplement listed on the label is inside the bottle, that the dose and potency are correctly reported and that the supplement is free of dangerous contaminants, like pesticides and heavy metals (lead, arsenic and mercury, for example). One way to check that a manufacturer follows good practices in preparing supplements is the stamp “USP verified” on the label. This means that the manufacturer of the supplement paid to have its product carefully tested by the U.S. Pharmacopeia (USP) for integrity, purity and safe manufacturing. Visit the USP website to see if a supplement has been USP verified.
 For a list of resources on safety information for CAM therapies, see the CAM Resources section.

Updated 03/11/09

Finding a CAM Provider

Once you’ve worked with your health care provider and decided that a complementary therapy may be right for you, the next step is finding a provider who specializes in the field in which you’re interested.

As in almost all aspects of CAM, the best place to start a search is with your health care provider. Many providers are affiliated with CAM practitioners through local hospitals or medical centers. Or, they may have previous experience with providers in your community and can steer you toward (or away from) certain practitioners.

Finding a licensed CAM practitioner is also a good step. While a license doesn’t guarantee good, safe care, it does mean that a provider has passed licensing requirements in his/her field. The four CAM professions most commonly licensed in the U.S. are: chiropractic (all states); acupuncture and traditional Chinese medicine (over 40 states); massage therapy (over 30 states); and naturopathic medicine (15 states and Washington D.C.) [24-26]. In addition, physicians and other health care providers (such as nurses, physical therapists and psychologists) can offer a variety of complementary therapies within the scope of their licensure. For example, dentists may integrate guided imagery, physical therapists may include massage therapy and nurses may use reiki and therapeutic touch. The websites below can be used to check the licensing status of many CAM providers:

It’s always important to have a brief meeting with a CAM provider, whether licensed or not, before getting any treatments. At this meeting, you should discuss:

  •  The provider’s experience treating people with cancer, qualifications, views on integrating complementary therapies with conventional treatments and general approach to treatment.
  • Your medical history and current medicines and your health care provider’s recommendations and contact information.
  • The potential benefits and risks from the treatment.
  • How much the treatment will cost. (Only a few complementary therapies are covered by health insurance plans.)


If you are not impressed by what you hear, or just feel that things didn’t seem quite right, do what you’d do in any similar situation in life--go somewhere else. Don’t settle for a provider just because you’ve taken the time and effort to find and meet with her/him. Keep looking until you find a provider that feels right.

Updated 03/11/09

Clinical Trials of Complementary Therapies

Clinical trials can provide essential information about the safety and effectiveness of new and existing complementary therapies. The number of well-designed clinical trials on complementary therapies is growing quickly. These trials take place across the country (and internationally) and in many types of medical centers and hospitals. To learn more about these trials, visit the websites below. Each site has a slightly different focus, so be sure to visit them all to get a complete picture of CAM clinical trials currently being offered. Use the search tools to narrow the list of trials. Then discuss this information with your health care provider.
National Center for Complementary and Alternative Medicine
National Library of Medicine
National Cancer Institute
Taking part in a clinical trial gives you the chance to use a complementary therapy in a well-monitored setting. It also advances scientific knowledge that can help others in the future. Participation in a clinical trial, though, is not without risks. It is important to talk with your health care provider before deciding to take part in any clinical trial—whether it’s for a complementary therapy or conventional treatment.

For more on clinical trials, see the Treatment section.

Updated 03/11/09

Seven Tips on CAM

Talk with your health care provider. When it comes to deciding whether or not to use complementary therapies, don’t go it alone. Your health care provider can help ensure that complementary therapies are well integrated with your standard treatments and can help to prevent harmful interactions. Talk with your provider so that together you can make informed decisions about what’s best for your health and well-being.
Use CAM only as an addition to standard treatment. Never replace standard cancer therapies with CAM therapies. Conventional therapies have proven benefits. Replacing these with less-studied CAM therapies can greatly increase the risk that a cancer will return or progress.
Take the initiative. When considering complementary therapies, learn all you can about the therapies you are interested in using: how safe they may be, how effective they are and how they may interact with any other conventional or complementary therapies you’re already using. In addition to the therapies described in Understanding Breast Cancer, the National Library of Medicine’s PubMed and the National Cancer Institute are good sources of scientific articles on CAM.
Be wary of wild claims. If a complementary therapy is said to cure cancer, be sure to do your research. See what the scientific evidence actually has to say about it. Your health care provider is a good resource for this information.
Don’t equate “natural” with “safe”. Natural does not mean safe. Think about poison ivy, poisonous mushrooms and rattlesnakes.
Go with reputable brands. With dietary supplements there’s little guarantee that what is on the label is what’s actually inside. Choosing supplements from known, reputable manufacturers may increase the likelihood that the supplement on the label is actually inside the bottle, that the dose and potency are accurately reported and that the supplement is free of dangerous contaminants. One way to check that a manufacturer follows good practices in preparing supplements is the stamp “USP verified” on the label. For more on this, or to see if a supplement has been USP verified, visit the USP website.
Go with licensed complementary therapy practitioners. Visiting a licensed practitioner isn’t a guarantee that you’ll get good, safe care. However, a license to practice does show that a provider has passed the licensing requirements in his/her CAM field.
 Updated 03/11/09

Questions to Ask Your Provider

Because complementary therapies can have harmful side effects and can interfere with your cancer treatment, it is important to talk to your health care provider of before using any of these therapies. The following list of questions can help you with that discussion.

Complementary and Alternative Medical (CAM) Therapies

  • How do you feel about complementary therapies?
  • Have you ever referred a patient to a CAM practitioner?
  • What’s the best way to find a certified CAM practitioner?
  • I am using these complementary therapies (name therapies). Should I stop them during and/or after my treatment?
  • Should I let you know before I start a complementary therapy? Which therapies should I be sure to avoid?
  • Is this complementary therapy (name therapy) safe? Is there research that shows it is safe? Will it interfere with my breast cancer treatment?
  • Are there side effects with this complementary therapy (name therapy)?
  • Is there a clinical trial studying this complementary therapy (name therapy)?

Disclaimer: This website is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of Breast Investigators LLC or its staff.