Plug the terms "alternative" and "cancer" into Google and the Internet search engine returns a list of 3.27 million - yes, million - sites with information both credible and questionable about nontraditional treatments for cancer. What's a cancer patient to make of such a vast array of options?
This "vast array" is known collectively as complementary and alternative medicine, or CAM. And the issue of how patients find information about CAM therapies is important, experts say, because not all are created equal. While some can be genuinely helpful to patients in treatment or remission, others are outright dangerous. Still others are too poorly studied to tell. Nevertheless, huge numbers of cancer patients use these therapies.
"I would guess that over 80% of cancer patients use … some form of complementary or alternative therapies," says Barrie Cassileth, PhD, chief of the Integrative Medicine Center at Memorial Sloan-Kettering Cancer Center in New York. "Patients can't distinguish which are good and which are harmful, and we've got to help them do that."
To that end, experts from around the country have collaborated to form the Society for Integrative Oncology. This new professional group is a joint effort of 3 major cancer centers with strong CAM programs -- Memorial Sloan-Kettering, MD Anderson Cancer Center in Houston, and Boston's Dana-Faber Cancer Institute -- as well as other cancer-related organizations, including the American Cancer Society. The new group holds its first conference in November.
The goal, says Cassileth, president of the Society for Integrative Oncology, is to promote high-level research of CAM and to get reliable information to doctors so they can guide their patients.
Some complementary therapies that patients use in conjunction with traditional cancer treatments - like chemotherapy, surgery, and radiation - can be very helpful, Cassileth said.
Acupuncture, for example, has been shown to be effective at reducing nerve pain, and is being tested as a remedy for hot flashes for women who can't take hormones (such as breast cancer patients). Mind-body therapies like meditation and hypnosis are being studied as ways to help control pain from medical procedures. Music therapy can help relieve depression in patients who are having stem cell transplants.
Doctors also need to know which therapies are bogus and potentially dangerous -- treatments typically considered "alternative" because patients may use them instead of scientifically studied treatments.
An article earlier this year in CA: A Cancer Journal for Clinicians (Vol. 54, No. 2: 110-118) reviewed the evidence for nearly a dozen alternative cancer therapies and found that they don't hold up under scrutiny. Among the therapies investigated were high-dose vitamin C, laetrile (a compound made from apricot pits), shark cartilage supplements, and the Gerson regimen (a purportedly detoxifying combination of diet and coffee enemas).
Such therapies should no longer be considered "unproven," wrote author Andrew Vickers, PhD, of Memorial Sloan-Kettering. Rather, "it is time to assert that many alternative therapies have been 'disproven,' " he said.
Then there are treatments that fall somewhere in between the "proven" and the "disproven" -- many herbs, for instance.
"Botanicals have tremendous potential, but they need to be studied," Cassileth said. "At this point, patients only have access to what's available over the counter in the form of supplements, but those are not a good idea to try and should be avoided because of their potential to interact negatively with traditional therapy."
Research is being conducted, she said, but the process is slow.
Despite the unknowns, herbal supplements are extremely popular. As many as 6 in 10 cancer patients use these remedies, according to some studies.
And quite often they don't tell their doctors about it. In one study, for instance, out of MD Anderson, researchers found that nearly half of women being treated for breast and gynecologic cancers used some type of herbal or vitamin supplement (Journal of Clinical Oncology Vol. 22, No. 4: 671-677). Yet only about half of these women informed their doctor.
"We kind of knew that patients weren't telling physicians about CAM use," said co-researcher Judith Smith, PharmD, BCOP. "Most of them don't even consider it medication."