Complementary Treatments for Cancer

Years ago, Western science dismissed these therapies -- now world-renowned medical centers see their patients' well-being improved by treatments like acupuncture and yoga.

A few days after being diagnosed with breast cancer in 2003, Lynne Greabell got another surprise: She was also pregnant. Carrying a baby can be stressful business, especially when you're 38, hold down a full-time job, and already have a toddler at home. But carrying a baby while fighting cancer -- that's a challenge not everyone can handle.

At least one doctor encouraged her to terminate the pregnancy, but Greabell, an administrator at an AIDS/HIV organization in Washington, D.C., decided to go on. She would need top-quality medical care -- including a mastectomy and carefully chosen chemotherapy -- to treat the disease while protecting her baby. Still, she soon discovered, surgery and medications can only take a person so far. With encouragement from her oncologist, Greabell meditated, went to yoga classes, had regular massage sessions, and tried acupuncture.

Nine months later, Greabell had a healthy baby boy and a clean bill of health. She also had newfound respect for complementary cancer treatments. "I felt like I had some control," she says. "I needed some positive energy to fight the disease," she says.

Into the mainstream

In recent years, many patients and cancer experts have embraced the idea that there's more to fighting cancer than cutting away tumors and blasting the body with drugs. A survey of more than 1,900 cancer survivors published in a 2007 issue of Complementary Therapies in Medicine found that 40 percent of patients had turned to some form of alternative treatment, most often herbs, deep breathing, and meditation.

In fact integrative medicine -- care that combines conventional treatment with complementary therapies such as acupuncture, yoga, meditation, herbs, and supplements -- is now embraced by first-rate medical centers. Forty-four prestigious medical institutions around the country and in Canada have established such programs or centers.

Oncologist Donald Abrams agrees that cancer patients need more than conventional treatment. Abrams is director of clinical programs at the Osher Center for Integrative Medicine, a division of the University of California at San Francisco Medical Center. He is both a cancer physician and a believer in complementary medicine.

"People who are given a diagnosis of cancer have had the locus of control removed from their universe, and they're now at the mercy of their doctors. I provide them with something they can do for themselves," Abrams says.

"Major cancer institutions are putting time, energy, and money into these programs because we see real benefits for patients," says Moshe Frenkel, MD, medical director of the Integrative Medicine Program at the University of Texas M.D. Anderson Cancer Center in Houston. While drugs and surgery attack cancer directly, integrative therapies are generally aimed at the rest of the patient, he says. The therapies can help ease pain, improve sleep, and give patients more physical and emotional strength to fight their disease. By protecting patients from the harmful effects of stress, the integrative approach can, in some cases, even help slow the disease and prolong life, he asserts. "It's science, not magic."

Even though established medical institutions are offering integrative health to cancer patients, there are still conventional doctors who view the centers with some apprehension. "I have skeptical colleagues across the street," says Abrams. "But as they see more and more of what I'm doing and they know I'm an oncologist, they send more and more patients."

Aside from conquering some skepticism from fellow clinicians, doctors recommending complementary treatments have to bear in mind that often health insurers won't pay for nonstandard care. Although doctors may heartily endorse them, nontraditional cancer treatments may be financially out of reach for some patients.

Abrams, credited with being a forward-thinking oncologist at San Francisco General Hospital in the early days of the AIDS epidemic, became interested back then in treatments that would boost patients' immune systems and help them feel better. Since then, he's tried to bridge an often uneasy gap between Western medicine and less conventional health practices from the East and other cultures.

He asks all the patients he sees at the Osher Center to describe how cancer has affected their lives. Then Abrams explains his view, likening cancer to a weed and the patient to a garden. "I tell them someone else is tending to their weed and my job is to make their soil as inhospitable as possible to the regrowth and spread of the weed," he says.

From the metaphorical, Abrams moves on to concrete recommendations that patients work with one of the Osher Center's Chinese medicine practitioners. He also gives solid advice about diet and supplements. "Often patients come to me with a shopping bag full of supplements that they don't feel comfortable disclosing to their oncologist," says Abrams. He tells them which ones may interact adversely with their cancer treatment and which ones may be helpful.

Healthy skepticism and debate

Clinicians emphasize that complementary doesn't mean anything goes. Anne Coscarelli, PhD, the director of the Simms/Mann-UCLA Center for Integrative Oncology, warns that many nontraditional treatments aren't much better than the proverbial snake oil. "There's a lot of misinformation and downright false information out there," she says. "So many different people are taking so many different things, and some of the products just aren't safe."

If you don't have access to an integrative health program or center in your area, you should be careful about the herbal remedies you take and talk to your doctor about them. While some herbs really are safe and effective -- ginger, when used correctly, may help ease nausea caused by chemotherapy -- many others are unproven and potentially dangerous.

Herbs can contain just as many active compounds as a prescription medication, but they are much less carefully regulated. In 2002, a popular herbal remedy for prostate cancer called PC-SPES was pulled off the market after tests showed that it was contaminated with prescription drugs that were never listed on the label. The product did seem to shrink tumors -- possibly thanks to those prescription drugs -- but it came with the undisclosed side effect of sapping sex drive.

Too many patients make the tragic mistake of shunning drugs, surgery, and radiation completely in hopes that alternative treatments can cure their disease. "We tell patients that they need conventional medicine as their primary treatment," Coscarelli says. A 2006 study of 33 breast cancer patients in the American Journal of Surgery confirmed what Coscarelli and other doctors already knew: For cancer patients, forgoing medical treatment can be a fatal mistake. The study found, among other things, that women who opted for homeopathy instead of surgery had a shorter life expectancy.

Proven approaches

At places like M.D. Anderson and the Simms/Mann-UCLA Center for Integrative Oncology, doctors stick with safe, proven approaches that can easily mesh with standard treatments. For example, the UCLA center offers acupuncture, acupressure, yoga classes, and massage therapy to help patients relax and cope with pain. All of these treatments were once on the fringe of medicine but have gained wide acceptance. According to the American Cancer Society, massage, for example, offers "great promise" for cancer patients struggling with anxiety, fatigue, depression, and pain.

Improving a patient's mood and outlook is often the top priority. As Coscarelli explains, "Cancer affects the whole person. There's a major psychological component." The center offers a variety of mood-boosting therapies to fit different needs and styles. Patients who want to talk about their experiences can join a support group, while those who prefer more solitary pursuits can find some peace of mind through meditation or art therapy.

Abrams encourages patients to seek out activities that give them joy. He also heartily advises patients to make use of stress-reduction practices, such as guided relaxation imagery, yoga, or meditation, and presents them with CDs that can talk them through exercises. "Stress doesn't cause cancer, but it's bad for it, because it releases adrenaline," Abrams says. The byproducts of adrenaline, he explains, have an unhealthy effect on the immune system.

Not every cancer patient lives near a major center for integrative oncology, but patients anywhere can take steps to improve their overall physical and emotional health. Getting advice from a nutritionist, signing up for a water aerobics class at the local Y, trying yoga or tai chi, joining a support group -- they're all steps in the right direction, away from the illness and toward recovery. Even though she no longer has cancer, Greabell still gets regular massages and spends a lot of time in the pool. With two young children to take care of, she needs to be at her best, in body and mind.

References

Interview with Lynne Greabell, breast cancer patient.

Interview with Anne Coscarelli, PhD, director of the Simms/Mann-UCLA Center for Integrative Oncology.

Interview with Mary Hardy, MD, medical director of the UCLA center for Integrative Oncology.

Interview with Moshe Frenkel, MD, medical director of the Integrative Medicine Program at M.D. Anderson Cancer Center.

Interview with Donald Abrams, MD, director of the Osher Center for Integrative Medicine at the University of California Medical Center in San Francisco.

American Cancer Society. Complementary and alternative methods for cancer management. 2007.

American Cancer Society. Dietary supplements: How to know what is safe. 2007.

National Center for Complementary and Alternative Medicine. What is CAM?

Mao, J.J. et al. Use of complementary and alternative medicine and prayer among a national sample of cancer survivors compared to other populations without cancer. Complementary Therapies in Medicine. 2007. 15(1): 21-29.

American Cancer Society. Massage. 2007.

Chang, E.Y. et al. Outcomes of breast cancer in patients who use alternative therapies as primary treatment. American Journal of Surgery. 2006. 192(4): 471-473.

Braun, S. et al. Cytokeratin-positive cells in the bone marrow and survival of patients with stage I, II, or III breast cancer. New England Journal of Medicine. 2000. 342: 525-533.

National Cancer Institute. Psychological stress and cancer: questions and answers.

Consortium of Academic health Centers for Integrative Medicine. About Us. May 2009.

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